Basic Information
| Provider Information | |||||||||
| NPI: | 1093892572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORKENEH-MARTIN | ||||||||
| FirstName: | LISHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WORKENEH | ||||||||
| OtherFirstName: | LISHAN | ||||||||
| OtherMiddleName: | T. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2081 PALOS VERDES DR N | ||||||||
| Address2: | |||||||||
| City: | LOMITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907173701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103256542 | ||||||||
| FaxNumber: | 3105173499 | ||||||||
| Practice Location | |||||||||
| Address1: | 2081 PALOS VERDES DR N | ||||||||
| Address2: | |||||||||
| City: | LOMITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907173701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103256542 | ||||||||
| FaxNumber: | 3105173499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 11/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | A76072 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.