Provider Demographics
NPI:1609031830
Name:CARISIO, LISA CRISTI (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CRISTI
Last Name:CARISIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LISIAHNA
Other - Middle Name:
Other - Last Name:HINOJOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1931
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-1931
Mailing Address - Country:US
Mailing Address - Phone:209-966-8143
Mailing Address - Fax:
Practice Address - Street 1:5067 HWY 140
Practice Address - Street 2:STE. A
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26064111N00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator