Provider Demographics
NPI:1780925628
Name:ARSOVA, LISA (LAC , DOM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ARSOVA
Suffix:
Gender:F
Credentials:LAC , DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 N COLLINS BLVD
Mailing Address - Street 2:SUITE 603
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2645
Mailing Address - Country:US
Mailing Address - Phone:214-730-0419
Mailing Address - Fax:
Practice Address - Street 1:2011 N COLLINS BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2645
Practice Address - Country:US
Practice Address - Phone:214-730-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01394171100000X
NM1084171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist