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General NPI Number Information
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NPI Number | 1962291914
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Entity Type | Individual
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Provider Name | LISA RANDER CHW MSW ACSW
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Gender | Female
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 41663 DATE ST STE 101B
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City | MURRIETA
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State | CA
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Zip | 92562-7078
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Country | US
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Telephone | 909-485-3880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 691
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City | SAN BERNARDINO
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State | CA
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Zip | 92402-0691
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Country | US
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Telephone | 909-853-8804
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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