Provider Demographics
NPI:1477757748
Name:LISA B ARIAN , MD
Entity Type:Organization
Organization Name:LISA B ARIAN , MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-443-0282
Mailing Address - Street 1:3830 VALLEY CENTRE DR 705 PMB 381
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92190-3307
Mailing Address - Country:US
Mailing Address - Phone:619-443-0282
Mailing Address - Fax:619-443-5337
Practice Address - Street 1:7910 FROST ST STE 325
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2791
Practice Address - Country:US
Practice Address - Phone:619-443-0282
Practice Address - Fax:619-443-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41690207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41690Medicare PIN