Provider Demographics
NPI:1528337177
Name:MARCINIAK, LISA M (CST, CFA, OPA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MARCINIAK
Suffix:
Gender:F
Credentials:CST, CFA, OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2650 N TENAYA WAY
Mailing Address - Street 2:#301
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1102
Mailing Address - Country:US
Mailing Address - Phone:702-878-0393
Mailing Address - Fax:702-939-5014
Practice Address - Street 1:2650 N TENAYA WAY
Practice Address - Street 2:#301
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1102
Practice Address - Country:US
Practice Address - Phone:702-878-0393
Practice Address - Fax:702-939-5014
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV081087OtherNATIONAL BOARD OF SURGICAL TECHNOLOGY & SURGICAL ASSISTING CERTIFICATE NUMBER