Provider Demographics
NPI:1275287963
Name:BARRAGAN, LIZANDRO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LIZANDRO
Middle Name:
Last Name:BARRAGAN
Suffix:
Gender:M
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 1:10527 VILLA VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2599
Mailing Address - Country:US
Mailing Address - Phone:209-607-1854
Mailing Address - Fax:
Practice Address - Street 1:1700 KEYSTONE PACIFIC PKWY UNIT B
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8874
Practice Address - Country:US
Practice Address - Phone:209-892-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant