Provider Demographics
NPI:1760744254
Name:CHANG, LISA S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10307 HINDERHILL DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-7035
Mailing Address - Country:US
Mailing Address - Phone:661-679-4246
Mailing Address - Fax:661-679-4246
Practice Address - Street 1:10307 HINDERHILL DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-7035
Practice Address - Country:US
Practice Address - Phone:661-679-4246
Practice Address - Fax:661-679-4246
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant