Provider Demographics
NPI:1962291914
Name:RANDER, LISA (CHW MSW ACSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RANDER
Suffix:
Gender:
Credentials:CHW MSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92402-0691
Mailing Address - Country:US
Mailing Address - Phone:909-853-8804
Mailing Address - Fax:
Practice Address - Street 1:41663 DATE ST STE 101B
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7078
Practice Address - Country:US
Practice Address - Phone:909-485-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker