Provider Demographics
NPI:1518030543
Name:LAW, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 PACIFIC AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4489
Mailing Address - Country:US
Mailing Address - Phone:415-986-0606
Mailing Address - Fax:415-986-7422
Practice Address - Street 1:728 PACIFIC AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4489
Practice Address - Country:US
Practice Address - Phone:415-986-0606
Practice Address - Fax:415-986-7422
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061395207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86017Medicare UPIN