Provider Demographics
NPI:1093846297
Name:LIZANO, EDWARD R-PEREZ (MD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:R-PEREZ
Last Name:LIZANO
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 910426
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92191-0426
Mailing Address - Country:US
Mailing Address - Phone:619-271-9923
Mailing Address - Fax:
Practice Address - Street 1:5550 PAINTED MIRAGE RD STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4584
Practice Address - Country:US
Practice Address - Phone:619-894-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52868Medicare ID - Type UnspecifiedSTATE LICENSE NUMBER