Provider Demographics
NPI:1043743024
Name:RAPISARDA, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RAPISARDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 BAYWOOD DR
Mailing Address - Street 2:202
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3347
Mailing Address - Country:US
Mailing Address - Phone:951-258-9715
Mailing Address - Fax:
Practice Address - Street 1:1840 BAYWOOD DR
Practice Address - Street 2:202
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3347
Practice Address - Country:US
Practice Address - Phone:951-258-9715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83613126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA83613Medicaid