Provider Demographics
NPI:1922385186
Name:DAVIS, LISA (HP, LMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:HP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 E THOUSAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3607
Mailing Address - Country:US
Mailing Address - Phone:818-300-3135
Mailing Address - Fax:
Practice Address - Street 1:3717 E THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3607
Practice Address - Country:US
Practice Address - Phone:818-300-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist