Healthcare Provider Details

I. General information

NPI: 1952361560
Provider Name (Legal Business Name): LISA MIA HOHL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 MARKS ST
HENDERSON NV
89014-6654
US

IV. Provider business mailing address

79 LOST MOUNTAIN CT
HENDERSON NV
89074-1755
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-1000
  • Fax:
Mailing address:
  • Phone: 702-671-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNV712
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: