Individual
MISS LISA MARIE MARGLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
6301 CUMBERLAND PL, STOCKTON, CA 95219-3661
(209) 640-1204
Mailing address
PO BOX 235, HERALD, CA 95638
(209) 395-8117
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
PT 38247
CA
311Z00000X
Custodial Care Facility
Primary
PT38249
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LPT38249
—
CA
Enumeration date
10/29/2015
Last updated
12/03/2019
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