Provider Demographics
NPI:1669925558
Name:WHITTON, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WHITTON
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 1:1699 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0721
Mailing Address - Country:US
Mailing Address - Phone:951-532-9050
Mailing Address - Fax:
Practice Address - Street 1:1699 SPYGLASS DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0721
Practice Address - Country:US
Practice Address - Phone:951-532-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6643172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker