Provider Demographics
NPI:1225508260
Name:LIZANO, JOSE MANUEL JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:LIZANO
Suffix:JR
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 1:6998 N US HIGHWAY 27 STE 105
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-3998
Mailing Address - Country:US
Mailing Address - Phone:352-732-2200
Mailing Address - Fax:844-273-1663
Practice Address - Street 1:6998 N US HIGHWAY 27 STE 105
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-3998
Practice Address - Country:US
Practice Address - Phone:352-732-2200
Practice Address - Fax:844-273-1663
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver