Individual
LISA SUZANNE BLACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-5434
Mailing address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A200136
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/08/2023
Last updated
05/18/2026
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