Provider Demographics
NPI:1346705696
Name:PLASENCIA, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PLASENCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41555 COOK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5184
Mailing Address - Country:US
Mailing Address - Phone:762-837-0033
Mailing Address - Fax:
Practice Address - Street 1:41555 COOK ST STE 100
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5184
Practice Address - Country:US
Practice Address - Phone:762-837-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA454412657OtherHR ADMIN