Healthcare Provider Details

I. General information

NPI: 1053241497
Provider Name (Legal Business Name): LISAKATIE SIAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 LINCOLN CTR
STOCKTON CA
95207-2642
US

IV. Provider business mailing address

1247 GREEN RIDGE DR
STOCKTON CA
95209-4538
US

V. Phone/Fax

Practice location:
  • Phone: 209-298-2320
  • Fax:
Mailing address:
  • Phone: 209-298-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number97241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: