Provider Demographics
NPI:1619938677
Name:NOYA, LISA S (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:NOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4304 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4811
Mailing Address - Country:US
Mailing Address - Phone:505-888-1075
Mailing Address - Fax:505-888-1082
Practice Address - Street 1:4304 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4811
Practice Address - Country:US
Practice Address - Phone:505-888-1075
Practice Address - Fax:505-888-1082
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD20020281207R00000X
NM2002-0281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM38536021Medicaid
NM38536021Medicaid
NM345509102Medicare ID - Type Unspecified
NM343712401Medicare UPIN