Provider Demographics
NPI:1033578299
Name:IRWIN, LISA MARIE (BA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1145
Mailing Address - Country:US
Mailing Address - Phone:714-447-7000
Mailing Address - Fax:714-447-7003
Practice Address - Street 1:401 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1145
Practice Address - Country:US
Practice Address - Phone:714-447-7000
Practice Address - Fax:714-447-7003
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033578299OtherNON-BILLABLE