Provider Demographics
NPI:1235268251
Name:SWENSSON, LISA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:SWENSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8240 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-5134
Mailing Address - Country:US
Mailing Address - Phone:916-965-7720
Mailing Address - Fax:
Practice Address - Street 1:1 SCRIPPS DR STE 202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6206
Practice Address - Country:US
Practice Address - Phone:916-927-1114
Practice Address - Fax:916-927-8721
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A829350Medicaid
CA106124OtherHEALTH NET
CA2403633OtherCIGNA
CA2464592OtherUNITED HEALTHCARE
CAA82935OtherBLUE CROSS
CAMCMG346100OtherWESTERN HEALTH ADVANTAGE
CA1851154OtherGREAT WEST
CA00A829350OtherBLUE SHIELD
CA000810611017OtherPHCS
CA236626OtherINTERPLAN
CA90142201OtherPACIFICARE
CA2240099OtherFIRST HEALTH
CA7666606OtherAETNA
CA00A829350Medicaid
CAA82935OtherBLUE CROSS