Individual
CLARISA ANDREA LISSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT25897
Contact information
Practice address
762 CYPRESS ST, SAN DIMAS, CA 91773
(909) 599-1227
Mailing address
762 CYPRESS ST, SAN DIMAS, CA 91773-3505
(909) 599-1227
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT25897
CA
Other
Enumeration date
12/10/2008
Last updated
08/23/2018
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