Provider Demographics
NPI:1093841439
Name:MEI, LISA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MEI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 PONDEROSA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-8613
Mailing Address - Country:US
Mailing Address - Phone:408-888-8163
Mailing Address - Fax:408-245-8469
Practice Address - Street 1:817 PONDEROSA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-8613
Practice Address - Country:US
Practice Address - Phone:408-888-8163
Practice Address - Fax:408-245-8469
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6458171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist