Healthcare Provider Details

I. General information

NPI: 1245513332
Provider Name (Legal Business Name): MS. LISA ELAINE SENADENOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2011
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 H ST
UNION CITY CA
94587-3452
US

IV. Provider business mailing address

34009 ALVARADO NILES RD
UNION CITY CA
94587-4452
US

V. Phone/Fax

Practice location:
  • Phone: 510-431-2899
  • Fax:
Mailing address:
  • Phone: 510-431-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number68047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: