Provider Demographics
NPI:1063239440
Name:BERNSTEIN-LAWLER, LISSA J'HANNA (MD)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:J'HANNA
Last Name:BERNSTEIN-LAWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISSA
Other - Middle Name:
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:324 CARRERA DR
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3997
Mailing Address - Country:US
Mailing Address - Phone:415-302-8527
Mailing Address - Fax:
Practice Address - Street 1:150 HARBOR DR SUITE 64
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-7704
Practice Address - Country:US
Practice Address - Phone:650-648-6192
Practice Address - Fax:866-736-8905
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine