=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285843839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA M HOSBEIN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 11/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10024 NEWTOWN ROAD
-----------------------------------------------------
City | NEVADA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-265-9600
-----------------------------------------------------
Fax | 530-265-9601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10024 NEWTOWN ROAD
-----------------------------------------------------
City | NEVADA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-265-9600
-----------------------------------------------------
Fax | 530-265-9601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | G68163
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------