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General NPI Number Information
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NPI Number | 1679656094
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Entity Type | Organization
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Legal Business Name | LISA MATZER, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 08/15/2010
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Provider Practice Location Address
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Address Line | 2121 W MAGNOLIA BLVD
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City | BURBANK
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State | CA
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Zip | 91506-1706
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Country | US
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Telephone | 818-840-9200
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Fax | 310-472-5828
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Provider Business Mailing Address
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Address Line | 2095 SUMMIT POINT DR
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City | LOS ANGELES
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State | CA
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Zip | 90049-6852
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Country | US
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Telephone | 310-472-5828
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Fax | 310-472-5828
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA MATZER
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Credential | M.D.
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Telephone | 310-472-5828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G67253
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License Number State | CA
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