Provider Demographics
NPI:1750487310
Name:CHODAK, LISA DIANE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:CHODAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:ARANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4987 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9364
Practice Address - Country:US
Practice Address - Phone:916-933-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52473207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0926165OtherCIGNA
CA133086OtherHEALTH NET
CA309748OtherINTERPLAN
CA00C524730OtherBLUE SHIELD
CA90206061OtherPACIFICARE
CAMCMG491300OtherWESTERN HEALTH ADVANTAGE
CA1268871OtherGREAT WEST
CAC52473OtherBLUE CROSS
CA000810818782OtherPHCS
CA00C524730Medicaid
CA5228393OtherFIRST HEALTH
CA5890742OtherAETNA
CA309748OtherINTERPLAN
CA00C524730Medicaid