Provider Demographics
NPI:1841028404
Name:SONG, LISA Z (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:Z
Last Name:SONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LANZHI
Other - Middle Name:
Other - Last Name:ZHENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1122 WHITE CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4054
Mailing Address - Country:US
Mailing Address - Phone:408-477-5641
Mailing Address - Fax:
Practice Address - Street 1:1122 WHITE CLIFF DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4054
Practice Address - Country:US
Practice Address - Phone:408-477-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse