Provider Demographics
NPI:1346371721
Name:FILLIS, LISA RAYLENE (ND)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:RAYLENE
Last Name:FILLIS
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Gender:F
Credentials:ND
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Mailing Address - Street 1:4301 ATLANTIC AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2833
Mailing Address - Country:US
Mailing Address - Phone:562-533-1909
Mailing Address - Fax:323-372-3836
Practice Address - Street 1:4301 ATLANTIC AVE STE 5
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2833
Practice Address - Country:US
Practice Address - Phone:562-533-1909
Practice Address - Fax:323-372-3836
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-08-28
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Provider Licenses
StateLicense IDTaxonomies
CAND11208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice