Provider Demographics
NPI:1902339799
Name:CAMPUZANO-MORA, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CAMPUZANO-MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 INDEPENDENCE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0381
Mailing Address - Country:US
Mailing Address - Phone:530-345-1600
Mailing Address - Fax:530-345-1685
Practice Address - Street 1:10 INDEPENDENCE CIR
Practice Address - Street 2:1297 PARK AVE
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0381
Practice Address - Country:US
Practice Address - Phone:530-345-1600
Practice Address - Fax:530-345-1685
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management