1982750121 NPI number — DR. ALBERT WILLIAM LIZARRARAS M.D.

Table of content: DR. ALBERT WILLIAM LIZARRARAS M.D. (NPI 1982750121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982750121 NPI number — DR. ALBERT WILLIAM LIZARRARAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIZARRARAS
Provider First Name:
ALBERT
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982750121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31561 TABLE ROCK DR
Provider Second Line Business Mailing Address:
#309
Provider Business Mailing Address City Name:
LAGUNA BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92651-8329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-499-5131
Provider Business Mailing Address Fax Number:
949-499-5131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 GENESEE AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-643-5650
Provider Business Practice Location Address Fax Number:
858-643-5660
Provider Enumeration Date:
01/27/2007

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: 207T00000X , with the licence number:  G11341 , 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)





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