Healthcare Provider Details

I. General information

NPI: 1477463024
Provider Name (Legal Business Name): LISA CREARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 TELEPHONE RD STE 117
VENTURA CA
93003-5672
US

IV. Provider business mailing address

4601 TELEPHONE RD STE 117
VENTURA CA
93003-5672
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-7033
  • Fax: 805-852-1906
Mailing address:
  • Phone: 805-642-7033
  • Fax: 805-852-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-PMOTUL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: