Provider Demographics
NPI:1902175623
Name:ASFAHANI, LISA ANTOINETTE (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANTOINETTE
Last Name:ASFAHANI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21832 CACTUS AVE.
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518
Mailing Address - Country:US
Mailing Address - Phone:951-924-6500
Mailing Address - Fax:855-306-0134
Practice Address - Street 1:21832 CACTUS AVE.
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518
Practice Address - Country:US
Practice Address - Phone:951-924-6500
Practice Address - Fax:855-306-0134
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant