Individual
DR. LISA ANN MANSUETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3200 S COUNTRY CLUB WAY, TEMPE, AZ 85282-4054
(480) 839-0206
(480) 831-6735
Mailing address
3200 S COUNTRY CLUB WAY, TEMPE, AZ 85282-4054
(480) 839-0206
(480) 831-6735
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
23840
AZ
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
23840
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3743063
CIGNA
AZ
05
—
455354
—
AZ
Enumeration date
06/30/2005
Last updated
05/09/2016
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