MEDICARE: LISA FISHMAN

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
1	106H00000X	Marriage & Family Therapist		CA

General Provider Information

NPI Number	:	1760345128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FISHMAN

Provider Business Mailing Address
First Line	:	5005 TEXAS ST STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3722
Country	:	US
Telephone Number	:	619-335-5096
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 TEXAS ST STE 106
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3722
Country	:	US
Telephone Number	:	619-335-5096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ LISA FISHMAN ” Practice Location

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