Provider Demographics
NPI:1073721304
Name:FRUTOS, LISA SONIA (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SONIA
Last Name:FRUTOS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 ESCALON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0501
Mailing Address - Country:US
Mailing Address - Phone:559-824-1828
Mailing Address - Fax:
Practice Address - Street 1:1107 O ST
Practice Address - Street 2:
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-2224
Practice Address - Country:US
Practice Address - Phone:559-659-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily