Provider Demographics
NPI:1235181454
Name:SISON LLANES, MARIA LUCILA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA LUCILA
Middle Name:
Last Name:SISON LLANES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA LUCILA
Other - Middle Name:SALVADOR
Other - Last Name:SISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1515 W CAMERON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2726
Mailing Address - Country:US
Mailing Address - Phone:626-814-0500
Mailing Address - Fax:626-814-0544
Practice Address - Street 1:1515 W CAMERON AVE STE 202
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2734
Practice Address - Country:US
Practice Address - Phone:626-814-0500
Practice Address - Fax:626-814-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA800902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A800900Medicaid
CA138427Medicare UPIN