Provider Demographics
NPI:1164458519
Name:CAMERINO, LISA LEE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:CAMERINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 LAUKAHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1361
Mailing Address - Country:US
Mailing Address - Phone:808-295-9100
Mailing Address - Fax:
Practice Address - Street 1:333 MERCY AVENUE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8319
Practice Address - Country:US
Practice Address - Phone:209-564-5000
Practice Address - Fax:209-385-7838
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8523207L00000X
CAG78306207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000226365OtherHMSA
494865-01OtherACS
52985Medicare UPIN
CACA243201Medicare PIN
494865-01OtherACS