Provider Demographics
NPI:1497843692
Name:MASTERSON, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1250 6TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1633
Mailing Address - Country:US
Mailing Address - Phone:310-451-9900
Mailing Address - Fax:310-394-0739
Practice Address - Street 1:1250 6TH ST STE 404
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1633
Practice Address - Country:US
Practice Address - Phone:310-451-9900
Practice Address - Fax:310-394-0739
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG80224207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG80224AMedicare ID - Type Unspecified
G84699Medicare UPIN