Individual
LISA MARIE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3100 SUMMIT ST FL 2, OAKLAND, CA 94609-3412
(510) 869-8865
(510) 869-6271
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(510) 869-8865
(510) 569-6271
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95006001
CA
363LF0000X
Family Nurse Practitioner
95006001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95006001
STATE MEDICAL LICENSE
CA
Enumeration date
04/21/2017
Last updated
06/09/2021
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