Individual
LISA NGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6801 PARK TER FL DRIVE2, LOS ANGELES, CA 90045-1543
(310) 665-7100
(310) 665-7101
Mailing address
11110 ALONDRA BLVD, NORWALK, CA 90650-6203
(626) 872-4169
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
50818
CA
Other
Enumeration date
11/10/2020
Last updated
08/04/2021
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