Provider Demographics
NPI:1972540599
Name:DAVIS, LISA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2970 HILLTOP MALL RD
Mailing Address - Street 2:STE #203
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1947
Mailing Address - Country:US
Mailing Address - Phone:510-222-8000
Mailing Address - Fax:510-222-2690
Practice Address - Street 1:2970 HILLTOP MALL RD
Practice Address - Street 2:STE #203
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1947
Practice Address - Country:US
Practice Address - Phone:510-222-8000
Practice Address - Fax:510-222-2690
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18325363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ70931Medicare UPIN
CA0PA183250Medicare PIN