Healthcare Provider Details

I. General information

NPI: 1184042889
Provider Name (Legal Business Name): LISA MARTINEZ FRANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4265
US

IV. Provider business mailing address

209 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4265
US

V. Phone/Fax

Practice location:
  • Phone: 253-596-3300
  • Fax: 253-596-3301
Mailing address:
  • Phone: 253-596-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number19713
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60904177
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number19713
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: