Provider Demographics
NPI:1104898238
Name:BENEST, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BENEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 W OLIVE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2459
Mailing Address - Country:US
Mailing Address - Phone:818-729-9149
Mailing Address - Fax:818-729-9119
Practice Address - Street 1:1624 W OLIVE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2459
Practice Address - Country:US
Practice Address - Phone:818-729-9149
Practice Address - Fax:818-729-9119
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77204207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG772040AMedicare ID - Type Unspecified
CAAY311Medicare PIN
CAG63815Medicare UPIN