Provider Demographics
NPI:1578798609
Name:CRISAN, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:CRISAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 BUNKER HILL WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-6010
Mailing Address - Country:US
Mailing Address - Phone:831-769-8800
Mailing Address - Fax:831-422-9312
Practice Address - Street 1:559 E ALISAL ST STE 200
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2516
Practice Address - Country:US
Practice Address - Phone:831-769-8807
Practice Address - Fax:831-422-9312
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70655FMedicaid
CAFCH70655FMedicaid