Healthcare Provider Details

I. General information

NPI: 1720952880
Provider Name (Legal Business Name): LISA M TEEVAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 TAPO ST STE 210
SIMI VALLEY CA
93063-3476
US

IV. Provider business mailing address

2139 TAPO ST STE 210
SIMI VALLEY CA
93063-3476
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-3000
  • Fax:
Mailing address:
  • Phone: 805-584-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: