Provider Information for 1912563248
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RYAN LISMAN MA, APCC
Sex: Male
NPI: 1912563248
Last Updated: 2019-05-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1912563248 | ||||||||
| Enumeration Date | 2019-05-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 712 COUNTRY OAKS CIR ARCADIA, CA 91006-2560 United States Phone: 818-397-2738 | Fax: | ||||||||
| Primary Practice Address | 16600 SHERMAN WAY VAN NUYS, CA 91406-3875 United States Phone: 818-386-1094 | Fax: | ||||||||
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