Provider Demographics
NPI:1265916845
Name:TIEBER NIELSON, LISA (DVM)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:TIEBER NIELSON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:TIEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-1207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 MISSION BELL DR
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3195
Practice Address - Country:US
Practice Address - Phone:510-235-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist