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NPI Code Detail

MEDICARE: MISS LISA L PRIETO M.S.

MEDICARE: MISS LISA L PRIETO M.S.
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
1106H00000XMarriage & Family Therapist
2106H00000XMarriage & Family Therapist110097CA

General Provider Information

NPI Number : 1487979019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LISA L PRIETO M.S.
Provider Business Mailing Address
First Line : 1908 BUSINESS CENTER DR STE 220
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3468
Country : US
Telephone Number : 909-890-5930
Fax Number :
Provider Business Practice Location Address
First Line : 1908 BUSINESS CENTER DR STE 220
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3468
Country : US
Telephone Number : 909-890-5930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2010
Last Update Date : 10/22/2018

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Directions to “ MISS LISA L PRIETO M.S.” Practice Location

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