Provider Demographics
NPI:1164438289
Name:LIZARDI, CARLOS A
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:A
Last Name:LIZARDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A21 CALLE 3
Mailing Address - Street 2:JARDINES DE CERRO GORDO
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-4505
Mailing Address - Country:US
Mailing Address - Phone:787-715-1124
Mailing Address - Fax:
Practice Address - Street 1:A21 CALLE 3
Practice Address - Street 2:JARDINES DE CERRO GORDO
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4505
Practice Address - Country:US
Practice Address - Phone:787-715-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR653225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant