Basic Information
| Provider Information | |||||||||
| NPI: | 1750487310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHODAK | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ARANDA | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | DIANE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4987 GOLDEN FOOTHILL PKWY | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957629364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169334222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | C52473 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0926165 | 01 | CA | CIGNA | OTHER | 133086 | 01 | CA | HEALTH NET | OTHER | 309748 | 01 | CA | INTERPLAN | OTHER | 00C524730 | 01 | CA | BLUE SHIELD | OTHER | 90206061 | 01 | CA | PACIFICARE | OTHER | MCMG491300 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 1268871 | 01 | CA | GREAT WEST | OTHER | C52473 | 01 | CA | BLUE CROSS | OTHER | 000810818782 | 01 | CA | PHCS | OTHER | 00C524730 | 05 | CA | MEDICAID | 5228393 | 01 | CA | FIRST HEALTH | OTHER | 5890742 | 01 | CA | AETNA | OTHER |