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General NPI Number Information
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NPI Number | 1033114160
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Entity Type | Individual
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Provider Name | LISA P MAESTAS D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 12410 E SINTO AVE STE B
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-2280
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Country | US
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Telephone | 509-838-2531
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Fax | 509-755-6580
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Provider Business Mailing Address
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Address Line | PO BOX 3649
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City | SPOKANE
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State | WA
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Zip | 99220-3649
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Country | US
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Telephone | 509-755-6580
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Fax | 509-755-6580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | OP60455816
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License Number State | WA
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