Provider Demographics
NPI:1285849604
Name:O'CONNELL, LISA C (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:O'CONNELL
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 1:7339 EL CAJON BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7435
Mailing Address - Country:US
Mailing Address - Phone:619-698-0606
Mailing Address - Fax:619-698-0609
Practice Address - Street 1:7339 EL CAJON BLVD STE I
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7435
Practice Address - Country:US
Practice Address - Phone:619-698-0606
Practice Address - Fax:619-698-0609
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29611Medicare UPIN