Healthcare Provider Details

I. General information

NPI: 1740617174
Provider Name (Legal Business Name): LISA R HUGHES PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 BEVERLY BLVD SUITE 200
WEST HOLLYWOOD CA
90048-1827
US

IV. Provider business mailing address

3501 BELLEVUE AVE APT 3
LOS ANGELES CA
90026-3504
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3981
  • Fax: 310-652-3906
Mailing address:
  • Phone: 908-489-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number23629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: