Provider Demographics
NPI:1295727741
Name:MATZER, LISA K (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:MATZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2095 SUMMIT POINT DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6852
Mailing Address - Country:US
Mailing Address - Phone:310-472-5828
Mailing Address - Fax:310-472-5828
Practice Address - Street 1:2121 W MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1706
Practice Address - Country:US
Practice Address - Phone:818-840-9200
Practice Address - Fax:310-472-5828
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG67253207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G673530Medicaid
CAWG67253EMedicare PIN
CAF85214Medicare UPIN
CAG67253Medicare ID - Type Unspecified