Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 20A 10571 | CA |
NPI | 1245415280 |
---|---|
Provider Name | Dr. Lisa M.m. Pitino |
First Address | Laguna Hills, CA 92653-3101 |
Second Address | Laguna Hills, CA 92691-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2008 |
Last Update Date | 06/04/2011 |