Individual
LISA LYNN PASSALACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(888) 959-5192
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(888) 959-5192
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
58543
CA
Other
Enumeration date
09/30/2020
Last updated
09/25/2023
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