Individual
LIISA MARIE TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12490 BUSINESS CENTER DR STE 100, VICTORVILLE, CA 92395-5833
(760) 552-8585
Mailing address
17100B BEAR VALLEY RD # 283, VICTORVILLE, CA 92395-5851
(209) 499-4604
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
494033
CA
207T00000X
Neurological Surgery Physician
494033
CA
2086S0127X
Trauma Surgery Physician
494033
CA
363L00000X
Nurse Practitioner
Primary
95019345
CA
Other
Enumeration date
10/13/2021
Last updated
09/10/2023
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