1043347495 NPI number — MRS. LISA CHARO BAIN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043347495 NPI number — MRS. LISA CHARO BAIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAIN
Provider First Name:
LISA
Provider Middle Name:
CHARO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHARO
Provider Other First Name:
LISA
Provider Other Middle Name:
NEIGHBOR
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043347495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 PARNASSUS AVE
Provider Second Line Business Mailing Address:
BOX 910 UCSF PEDICATRICS
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94143-0110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-476-1000
Provider Business Mailing Address Fax Number:
415-476-5645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 PARNASSUS AVE
Provider Second Line Business Practice Location Address:
UCSF
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94143-0110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-476-1000
Provider Business Practice Location Address Fax Number:
415-476-5645
Provider Enumeration Date:
02/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L-228673 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: A108858 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)