Provider Demographics
NPI:1952841322
Name:BRUCE, LISA (CPCP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2634
Mailing Address - Country:US
Mailing Address - Phone:510-900-1172
Mailing Address - Fax:
Practice Address - Street 1:1225 MARIN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2044
Practice Address - Country:US
Practice Address - Phone:510-900-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT0314282246ZA2600X
246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical