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NPI Code Detail

MEDICARE: MS. LISA ROBERTA CANO

MEDICARE: MS. LISA ROBERTA CANO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1134383052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA ROBERTA CANO
Provider Business Mailing Address
First Line : 5122 W AVENUE L2
Second Line :
City : LANCASTER
State : CA
Zip : 93536-4351
Country : US
Telephone Number : 310-427-9225
Fax Number :
Provider Business Practice Location Address
First Line : 44443 10TH ST W
Second Line :
City : LANCASTER
State : CA
Zip : 93534-3346
Country : US
Telephone Number : 661-726-2630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2008
Last Update Date : 02/06/2017

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