Individual
LISA S DERITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1280 CENTRAL BLVD STE J5, BRENTWOOD, CA 94513-2362
(925) 250-2908
Mailing address
4549 LARIAT LN, OAKLEY, CA 94561-1718
(925) 250-2908
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95025065
CA
Other
Enumeration date
06/07/2023
Last updated
06/07/2023
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