Provider Demographics
NPI:1265028161
Name:ARIAS, LIZETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:ARIAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18770 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2745
Mailing Address - Country:US
Mailing Address - Phone:786-281-2022
Mailing Address - Fax:
Practice Address - Street 1:3850 BIRD RD STE 402B
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1507
Practice Address - Country:US
Practice Address - Phone:305-667-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113761363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant