Provider Demographics
NPI:1225135965
Name:CUA, LIZA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:A
Last Name:CUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIZA
Other - Middle Name:A
Other - Last Name:CUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-7942
Practice Address - Street 1:91400 N. NEACOXIE STREET
Practice Address - Street 2:BLDG 7315
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:800-949-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072297Medicaid
OHF01453Medicare UPIN
OHH145670Medicare PIN