Provider Demographics
NPI:1487010211
Name:CASANOVA-SIDOTI, LISA ANNE (RNFA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:CASANOVA-SIDOTI
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16901 AIRPORT CIR
Mailing Address - Street 2:UNIT 105
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4042
Mailing Address - Country:US
Mailing Address - Phone:714-717-3841
Mailing Address - Fax:
Practice Address - Street 1:16901 AIRPORT CIR
Practice Address - Street 2:UNIT 105
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4042
Practice Address - Country:US
Practice Address - Phone:714-717-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA849362282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital