Provider Demographics
NPI:1275732885
Name:SWEARINGEN, LISA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:SWEARINGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:EHRENSBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2320 WOOLSEY ST
Mailing Address - Street 2:#301
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1973
Mailing Address - Country:US
Mailing Address - Phone:510-849-1744
Mailing Address - Fax:510-849-0326
Practice Address - Street 1:2320 WOOLSEY ST
Practice Address - Street 2:#301
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1973
Practice Address - Country:US
Practice Address - Phone:510-849-1744
Practice Address - Fax:510-849-0326
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics