Provider Demographics
NPI:1659139301
Name:FISHER, LORENA AIDE (MA/ CPT 1)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:AIDE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MA/ CPT 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 9TH ST APT A7
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3598
Mailing Address - Country:US
Mailing Address - Phone:714-278-2421
Mailing Address - Fax:
Practice Address - Street 1:8021 9TH ST APT A7
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3598
Practice Address - Country:US
Practice Address - Phone:714-278-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-00044760246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy