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General NPI Number Information
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NPI Number | 1326489014
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Entity Type | Individual
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Provider Name | LISA MARIE NEVITT PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 455 OCONNOR DR SUITE 150
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City | SAN JOSE
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State | CA
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Zip | 95128-1633
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Country | US
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Telephone | 408-298-8770
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Fax | 408-298-8710
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Provider Business Mailing Address
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Address Line | 400 RACE ST
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City | SAN JOSE
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State | CA
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Zip | 95126-3518
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Country | US
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Telephone | 408-278-3500
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Fax | 408-278-3592
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA22923
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License Number State | CA
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