Healthcare Provider Details

I. General information

NPI: 1649430364
Provider Name (Legal Business Name): LISA MICHELE ARCILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3084
US

IV. Provider business mailing address

106 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3084
US

V. Phone/Fax

Practice location:
  • Phone: 925-239-2900
  • Fax:
Mailing address:
  • Phone: 925-239-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA112061
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA112061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: