Provider Demographics
NPI:1457831307
Name:MCCLAIN, LISA MARIE (RCP RRT RRT SDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:RCP RRT RRT SDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27300 IRIS AVE RM 2415
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4802
Mailing Address - Country:US
Mailing Address - Phone:951-251-6209
Mailing Address - Fax:
Practice Address - Street 1:27300 IRIS AVE RM 2415
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4802
Practice Address - Country:US
Practice Address - Phone:951-251-6209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP10890227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO$$$$$$$$$OtherSOCIAL SECURITY