=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366312399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. LISA DECORDOVA-HILL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23625 HOLMAN HWY
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-625-4553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15046 BRECKINRIDGE AVE
-----------------------------------------------------
City | EAST GARRISON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93933-5075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-625-4553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471Q0001X
-----------------------------------------------------
Taxonomy Name | Quality Management Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------