Provider Demographics
NPI:1205398815
Name:LIZARRAGA, DAVID LEODEGARIO (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEODEGARIO
Last Name:LIZARRAGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 TURNER RIDGE DR APT 6202
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-7408
Mailing Address - Country:US
Mailing Address - Phone:719-331-3857
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR # MC7742
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program