=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548803323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA GONZALES CHAPA FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2019
-----------------------------------------------------
Last Update Date | 02/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 N LAFAYETTE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93728-1123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-457-6860
-----------------------------------------------------
Fax | 559-457-6859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 E SPRUCE AVE STE 431
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-450-7449
-----------------------------------------------------
Fax | 559-450-7470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95012023
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------