Provider Demographics
NPI:1023806460
Name:CLINTON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CLINTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WATERMAN BLVD # A4-206
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1800
Mailing Address - Country:US
Mailing Address - Phone:415-713-8725
Mailing Address - Fax:
Practice Address - Street 1:1709 SONOMA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6011
Practice Address - Country:US
Practice Address - Phone:415-713-6573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator