Healthcare Provider Details

I. General information

NPI: 1629969381
Provider Name (Legal Business Name): LISA M BATES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

11733 VALLEYCREST RD
STUDIO CITY CA
91604-4227
US

IV. Provider business mailing address

11733 VALLEYCREST RD
STUDIO CITY CA
91604-4227
US

V. Phone/Fax

Practice location:
  • Phone: 323-574-4702
  • Fax:
Mailing address:
  • Phone: 323-574-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: