Individual
LISA MONIQUE BODON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
555 E TACHEVAH DR, SUITE 2W #201, PALM SPRINGS, CA 92262-5750
(760) 323-9309
(760) 610-8995
Mailing address
555 E TACHEVAH DR, SUITE 2W #201, PALM SPRINGS, CA 92262-5750
(760) 323-9309
(760) 610-8995
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A97869
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A978690
—
CA
05
—
GR0042690
—
CA
01
—
ZZZ50078Y
BLUE SHIELD
CA
Enumeration date
07/02/2007
Last updated
11/20/2012
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