Provider Demographics
NPI:1922138502
Name:SAHAGUN, LISA MICHELLE (ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:SAHAGUN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N FESTIVAL DR APT 501
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6241
Mailing Address - Country:US
Mailing Address - Phone:586-604-9704
Mailing Address - Fax:
Practice Address - Street 1:200 N FESTIVAL DR APT 501
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6241
Practice Address - Country:US
Practice Address - Phone:586-604-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer