Provider Information for 1700254729
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LISA OMORI L.P.C.
Sex: Female
NPI: 1700254729
Last Updated: 2015-09-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1700254729 | ||||||||
| Enumeration Date | 2015-09-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 915 PARKCENTRE WAY STE 7 NAMPA, ID 83651-1748 United States Phone: 208-442-7791 | Fax:208-442-7791 | ||||||||
| Primary Practice Address | 915 PARKCENTRE WAY STE 7 NAMPA, ID 83651-1748 United States Phone: 208-442-7791 | Fax:208-442-7791 | ||||||||
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