Provider Demographics
NPI:1942742846
Name:LASIAN, MONA LIZA
Entity Type:Individual
Prefix:MS
First Name:MONA LIZA
Middle Name:
Last Name:LASIAN
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 1:3516 ELM AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3915
Mailing Address - Country:US
Mailing Address - Phone:562-338-0495
Mailing Address - Fax:
Practice Address - Street 1:3516 ELM AVE APT 305
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3915
Practice Address - Country:US
Practice Address - Phone:562-338-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30244OtherPT LICENSE NUMBER