Provider Demographics
NPI:1841288297
Name:LUMAR, LISA L (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:LUMAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12746 PACIFIC AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4237
Mailing Address - Country:US
Mailing Address - Phone:503-422-7184
Mailing Address - Fax:
Practice Address - Street 1:501 E HARDY ST STE 205
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4021
Practice Address - Country:US
Practice Address - Phone:310-671-6364
Practice Address - Fax:217-545-7127
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002708363AM0700X
CA20985363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99639Medicare UPIN