Provider Demographics
NPI:1558585950
Name:STERN, LISA C (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 10TH ST.
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2838
Mailing Address - Country:US
Mailing Address - Phone:310-458-1714
Mailing Address - Fax:310-394-8754
Practice Address - Street 1:1450 10TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2838
Practice Address - Country:US
Practice Address - Phone:310-458-1714
Practice Address - Fax:310-394-8754
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG66991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics