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General NPI Number Information
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NPI Number | 1083699078
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Entity Type | Individual
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Provider Name | LISSA C DAIMARU-ENOKI M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 14406 NE 20TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98686-1448
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Country | US
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Telephone | 360-571-4244
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Fax | 360-571-4246
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Provider Business Mailing Address
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Address Line | 14406 NE 20TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98686-1448
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Country | US
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Telephone | 360-571-4244
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Fax | 360-571-4246
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 32929
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD 60170420
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License Number State | WA
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