Provider Demographics
NPI:1174057442
Name:ROPER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BERKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-4862
Mailing Address - Country:US
Mailing Address - Phone:415-320-0906
Mailing Address - Fax:
Practice Address - Street 1:101 N FRONT ST
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2916
Practice Address - Country:US
Practice Address - Phone:559-665-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN233222171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator