Individual
LISA ODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, CPNP
Contact information
Practice address
12820 PIONEER BLVD, NORWALK, CA 90650-2875
(562) 868-0431
(562) 868-1297
Mailing address
1110 N CALERA AVE, COVINA, CA 91722-2822
(626) 915-3303
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
563201
CA
Other
Enumeration date
01/25/2010
Last updated
01/25/2010
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