Mary Debra Lasisi

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

6010 Issued in CA

Practice address

18333 Dolan Way Ste 103
Canyon Country, CA 91387-5422

Phone

(661) 214-7174

NPI assigned

Mar 10, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1073148060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17216 SATICOY ST # 141",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914062103",
            "telephone_number": "818-206-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18333 DOLAN WAY STE 103",
            "city": "CANYON COUNTRY",
            "state": "CA",
            "postal_code": "913875422",
            "telephone_number": "661-214-7174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASISI",
        "first_name": "MARY DEBRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "6010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krishan K Vashistha, MD Inc.
• Eric P Kuehne, M.D.
• Ron Kusek, NSCA-CPT, CTNC, FAS
• Vernon Henry Lackman, M.D.
• Edward C Landon, O.D.
• Carissa Ariel Lataillade, LMFT
• Ira S Latto, MD
• Mikaela Angela Vistan Leano, FNP-C
• Byong-Wha Esther Lee, MD
• Jordan Wing Lee, PHARMD

• Speech-Language Assistant in Canyon Country, CA
• Providers in Canyon Country, CA by specialty
• Speech-Language Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.