Provider Demographics
NPI:1205049665
Name:LISA MAJER DO A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LISA MAJER DO A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAJER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-452-7515
Mailing Address - Street 1:24411 HEALTH CENTER DR
Mailing Address - Street 2:STE 510
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3651
Mailing Address - Country:US
Mailing Address - Phone:949-452-7515
Mailing Address - Fax:949-452-7511
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:STE 510
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3651
Practice Address - Country:US
Practice Address - Phone:949-452-7515
Practice Address - Fax:949-452-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5523A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF01144Medicare UPIN
CAW20A5523AMedicare ID - Type Unspecified