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General NPI Number Information
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NPI Number | 1902371016
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Entity Type | Individual
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Provider Name | LISA DO
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Gender | Female
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 2750 E WASHINGTON BLVD STE 230
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City | PASADENA
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State | CA
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Zip | 91107-1449
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Country | US
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Telephone | 626-296-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 11336 LOWER AZUSA RD
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City | EL MONTE
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State | CA
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Zip | 91732-1329
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Country | US
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Telephone | 626-478-7812
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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