Individual
LISA MADALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1630 E HERNDON AVE, FRESNO, CA 93720-3305
(559) 256-5200
(559) 256-5376
Mailing address
2050 S BLOSSER RD, SANTA MARIA, CA 93458-7310
(559) 256-5200
(559) 256-5376
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP15802
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15802
NURSE PRACTITIONER FURNISHING LICENSE
—
01
—
499652
RN LICENSE
CA
Enumeration date
08/14/2006
Last updated
04/22/2020
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