Provider Demographics
NPI:1356495352
Name:JUSTICE, LISA (LPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S SANTA ANITA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6853
Mailing Address - Country:US
Mailing Address - Phone:626-254-5000
Mailing Address - Fax:
Practice Address - Street 1:13950 MILTON AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-2900
Practice Address - Country:US
Practice Address - Phone:714-901-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25000167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician