Provider Demographics
NPI:1346768934
Name:OBREGON, LISA LEANNE (RN, NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LEANNE
Last Name:OBREGON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11880 BERNARDO TER UNIT E
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1915
Mailing Address - Country:US
Mailing Address - Phone:619-517-5589
Mailing Address - Fax:
Practice Address - Street 1:3075 HEALTH CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2773
Practice Address - Country:US
Practice Address - Phone:858-637-7888
Practice Address - Fax:858-637-7887
Is Sole Proprietor?:No
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006820363L00000X
CA549679163W00000X
CA4607364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist