Provider Demographics
NPI:1891920716
Name:RAKUSIN, LISA L
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:L
Last Name:RAKUSIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3342 WIMBLETON DR
Mailing Address - Street 2:
Mailing Address - City:ROSSMOOR
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3853
Mailing Address - Country:US
Mailing Address - Phone:562-754-3331
Mailing Address - Fax:
Practice Address - Street 1:704 W 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3017
Practice Address - Country:US
Practice Address - Phone:310-832-7545
Practice Address - Fax:310-833-8580
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health