Lisa Renee Di Enno, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

C162286 Issued in CA

Practice address

3020 Childrens Way
San Diego, CA 92123-4223

Phone

(858) 966-8800

NPI assigned

Jun 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Lisa Renee Rose Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Xpertcare Medical Group PC

  • Pediatrics Physician
  • San Diego, CA
  • NPI 1720637820
  NPD Authorized official
• Marilyn Kaufhold, M.D., a Medical Corporation

  • Children's Hospital
  • San Diego, CA
  • NPI 1336359389
  NPD (past)
• Providence Pediatric Practice LLC

  • Pediatrics Physician
  • Media, PA
  • NPI 1932160629
  NPD (past)

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1407050297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DI ENNO",
        "first_name": "LISA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101245344",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C162286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "ROSE",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ramandeep Kaur Dhillon
• Ramandeep Singh Dhillon, M.D.
• Sanjay Dhir, D.D.S.
• Pawen Dhokal
• Sarah Lyn Di Benedetto, MD
• Ronald P. Di Giacomo, MD
• Anna Di Nardo, M.D.
• Alexander Di Norscia
• Gregory Christopher Di Rocco, MD
• William Joseph Di Zinno, DMD

• Pediatrics Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.