Provider Demographics
NPI:1285850792
Name:LISA B CASSILETH, MD, INC
Entity Type:Organization
Organization Name:LISA B CASSILETH, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSILETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-278-8200
Mailing Address - Street 1:436 N BEDFORD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4323
Mailing Address - Country:US
Mailing Address - Phone:310-278-8200
Mailing Address - Fax:
Practice Address - Street 1:436 N BEDFORD DR STE 103
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4323
Practice Address - Country:US
Practice Address - Phone:310-278-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty