Provider Demographics
NPI:1699042960
Name:SPITALEWITZ, LISA MIRA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MIRA
Last Name:SPITALEWITZ
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:2288 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1506
Practice Address - Country:US
Practice Address - Phone:415-964-4855
Practice Address - Fax:415-965-7940
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2019-02-06
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Provider Licenses
StateLicense IDTaxonomies
CAPA21716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant