Provider Demographics
NPI:1073628459
Name:BARDEN, LISA MICHELE (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:BARDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELE
Other - Last Name:VANDERBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 N PALM CANYON DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4414
Mailing Address - Country:US
Mailing Address - Phone:760-327-7900
Mailing Address - Fax:760-327-7905
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:SUITE 212
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-327-7900
Practice Address - Fax:760-327-7905
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8063207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology