Provider Demographics
NPI:1831482207
Name:RAJALA, LISA DIEHL (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DIEHL
Last Name:RAJALA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:468 PENNSFIELD PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5570
Mailing Address - Country:US
Mailing Address - Phone:805-379-1616
Mailing Address - Fax:805-379-4848
Practice Address - Street 1:468 PENNSFIELD PL
Practice Address - Street 2:SUITE 102
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5570
Practice Address - Country:US
Practice Address - Phone:805-379-1616
Practice Address - Fax:805-379-4848
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
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Provider Licenses
StateLicense IDTaxonomies
CAG65220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine