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General NPI Number Information
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NPI Number | 1154652543
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Entity Type | Individual
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Provider Name | LISA ODA RN, MSN, CPNP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 12820 PIONEER BLVD
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City | NORWALK
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State | CA
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Zip | 90650-2875
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Country | US
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Telephone | 562-868-0431
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Fax | 562-868-1297
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Provider Business Mailing Address
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Address Line | 1110 N CALERA AVE
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City | COVINA
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State | CA
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Zip | 91722-2822
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Country | US
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Telephone | 626-915-3303
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 563201
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License Number State | CA
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