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Individual
LISA SUSAN MARK
Active
Individual
LISA SUSAN MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12333
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902846306
GROUP NPI
CA
01
—
GR0100430
GROUP MEDICAL
CA
01
—
W18762
GROUP MEDICARE
CA
Enumeration date
07/27/2011
Last updated
03/08/2016
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