Individual
LISA SHANE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2801 ATLANTIC AVE, LONG BEACH, CA 90806-1737
(562) 933-0713
Mailing address
17601 RAINGLEN LN, HUNTINGTON BEACH, CA 92649-4727
(714) 377-5817
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G078893
CA
Other
Enumeration date
05/02/2006
Last updated
01/11/2012
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