Provider Demographics
NPI:1770792822
Name:FLORES, LISA BERNING (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:BERNING
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:CHRISTINE
Other - Last Name:BERNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:13652 CANTARA ST
Mailing Address - Street 2:KAISER DEPT. OF PAIN MANAGEMENT
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5423
Mailing Address - Country:US
Mailing Address - Phone:818-375-3619
Mailing Address - Fax:818-375-3668
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:KAISER DEPT. OF PAIN MANAGEMENT
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-3619
Practice Address - Fax:818-375-3668
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16880103T00000X, 103TB0200X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic