Provider Demographics
NPI:1073588349
Name:LIZASOAIN, JOSE ANGEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:LIZASOAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336060
Mailing Address - Street 2:MAYOR ST 2651
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2072
Mailing Address - Country:US
Mailing Address - Phone:787-840-8383
Mailing Address - Fax:787-840-1582
Practice Address - Street 1:MAYOR ST 2651
Practice Address - Street 2:DR JOSE A LIZASOGIN OFFICE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2072
Practice Address - Country:US
Practice Address - Phone:787-840-8383
Practice Address - Fax:787-840-1582
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics