Provider Demographics
NPI:1184187361
Name:DIPINTO, LISA MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:DIPINTO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CLEMENT FERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:8327 E FLOWERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4578
Mailing Address - Country:US
Mailing Address - Phone:714-771-3350
Mailing Address - Fax:
Practice Address - Street 1:7401 YORKTOWN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2757
Practice Address - Country:US
Practice Address - Phone:714-536-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22056208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation