LISA DEPTULA (NPI# 1184052508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184052508 |
| Entity Type | Individual |
| Full Name | LISA DEPTULA |
| Credential | PA-C |
| Practice Address |
2144 4th St Ste A San Rafael CA 94901 |
| Mailing Address |
2144 4th St Ste A San Rafael CA 94901-2668 |
| Practice Telephone | 4153902060 |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2018-12-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA54017 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 5601006710 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 203 Winston Dr, Marshall, MI 490688526 | 2697891670 |
| Street Address |
2144 4TH ST STE A |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780207134 | Marianne Haissman Stefancic | Marriage & Family Therapist | 409 Forbes Ave., San Rafael, CA 94901 | 2020-05-20 |
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1275052516 | Laura Ellen Silverstein | Marriage & Family Therapist | 600 Fifth Avenue, San Rafael, CA 94901 | 2017-09-19 |
| 1689101107 | Marin Family Recovery | Clinic/Center | 1209 Third St. Ste 4, San Rafael, CA 94901 | 2017-05-15 |
| 1376070011 | Tencia Beavers-sanchez | Counselor | 710 C Street Suite#8, Marin Outpatient&recoveryservices, Sanrafael, CA 94901 | 2017-05-12 |
| 1326584905 | Jamie Waterman | Emergency Medical Technician, Basic | 675 Sir Francis Drake Blvd, Kentfield, CA 94901 | 2017-01-06 |
| 1295270676 | Stephen Marks | Counselor | 900 Fifth Avenue, Suite 150, ; San Rafael, CA 94901 | 2016-12-21 |
| 1497299812 | Vesna Sturman | Psychologist | 712 D St Ste L, San Rafael, CA 94901 | 2016-12-05 |
| 1063955771 | Carol Dutton Hollenberg | Behavior Technician | 503 D St., San Rafael, CA 94901 | 2016-11-29 |
| 1083069447 | Bay Area Community Resources | Community/Behavioral Health | 103 Shoreline Parkway, San Rafael, CA 94901 | 2016-05-04 |
| Find all providers in zip 94901 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245329606 | Veronica A Gonzales | Physician Assistant | 36 Rustic Way, San Rafael, CA 94901-1118 | 2006-10-12 |
| 1598327967 | Jessica Tan | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2230 | 2019-07-05 |
| 1902469364 | Dorien Johnk | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2230 | 2019-04-20 |
| 1992368419 | Huong Le Bui | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2230 | 2019-04-19 |
| 1972166478 | Michelle Lauren Fisher | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2230 | 2019-04-19 |
| 1639632847 | Evelyn Joan Fahey | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2298 | 2019-04-13 |
| 1659833291 | Julie Blanchard | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2230 | 2019-04-02 |
| 1114488814 | Chantilay Ruffin | Physician Assistant | 50 Acacia Ave, Meadowlands 302, San Rafael, CA 94901-2230 | 2019-03-26 |
| 1922568856 | Audrey Elizabeth Schneider-hawes | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2230 | 2019-03-25 |
| 1487114534 | Torsten Hall Durkan | Physician Assistant | 50 Acacia Ave, San Rafael, CA 94901-2230 | 2019-03-24 |
| Find all providers in SAN RAFAEL | ||||
| City | SAN RAFAEL |
| Zip Code | 94901 |
Please comment or provide details below to improve the information on LISA DEPTULA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.