Individual
LISA M GLEASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
685 MORRO AVE STE C, MORRO BAY, CA 93442-2233
(805) 772-7313
(805) 772-0395
Mailing address
685 MORRO AVE STE C, MORRO BAY, CA 93442-2233
(805) 772-7313
(805) 772-0395
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
A108043
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB255979
MEDICARE PTAN
CA
Enumeration date
05/30/2007
Last updated
11/02/2023
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