Basic Information
| Provider Information | |||||||||
| NPI: | 1720133739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RADER | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50706 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931500706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059633336 | ||||||||
| FaxNumber: | 8055643332 | ||||||||
| Practice Location | |||||||||
| Address1: | 5370 HOLLISTER AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931112396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056969600 | ||||||||
| FaxNumber: | 8056969000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 409223 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.