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General NPI Number Information
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NPI Number | 1548502644
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Entity Type | Individual
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Provider Name | LISA KAY TRITICO N.P
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Gender | Female
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLZ SUITE 660
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-794-7475
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Fax | 310-206-1060
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Provider Business Mailing Address
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Address Line | 4227 MENTONE AVE
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City | CULVER CITY
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State | CA
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Zip | 90232
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Country | US
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Telephone | 310-839-3565
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Fax | 310-206-1060
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 380372
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License Number State | CA
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