Individual provider · NPI-1

Lisa Michelle Kotler, PA-C

Physician Assistant · La Habra, CA

NPI number1801349774
StatusActive
Last updated in NPPESMay 19, 2021

Details

NPI
1801349774
Entity type
Individual (NPI-1)
Name
Mrs. Lisa Michelle Kotler
Credential
PA-C
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 27, 2016
Certification date
May 18, 2021
Last updated
May 19, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant59311CAYes
363AM0700X Physician Assistant, MedicalC5-0001080DE

Practice location

1040 W Imperial Hwy
La Habra, CA 90631-0608

Phone 715-451-1072 · Fax 714-451-1078

Mailing address

2403 Ralston Ln
Redondo Beach, CA 90278-5121

Phone 484-574-1011

Other practice locations

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

Phone 302-733-1000

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