Healthcare Provider Details

I. General information

NPI: 1487257366
Provider Name (Legal Business Name): LISA CHAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W CIVIC CENTER DR STE 120
SANTA ANA CA
92703-2380
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-8501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number58873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: