Provider Demographics
NPI:1568796803
Name:LAM, LISA SANGLY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SANGLY
Last Name:LAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:SANGLY
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1789 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-4130
Mailing Address - Country:US
Mailing Address - Phone:626-487-8080
Mailing Address - Fax:
Practice Address - Street 1:1011 BALDWIN PARK BLVD, URGENT CARE DEPARTMENT
Practice Address - Street 2:URGENT CARE DEPARTMENT
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5806
Practice Address - Country:US
Practice Address - Phone:626-851-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA953543658207R00000X
CAPA20106363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine