Provider Demographics
NPI:1922009067
Name:BANH, LISA K (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BANH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9041 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-343-3477
Mailing Address - Fax:951-343-3483
Practice Address - Street 1:9041 MAGNOLIA AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3900
Practice Address - Country:US
Practice Address - Phone:951-343-3477
Practice Address - Fax:951-343-3483
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16495207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16495OtherPHYSICIAN ASS LICENCE#