Provider Demographics
NPI:1316038045
Name:CHAVEZ, LIZA DOMINGUEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:DOMINGUEZ
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 14642
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90853-4642
Mailing Address - Country:US
Mailing Address - Phone:562-633-2204
Mailing Address - Fax:562-633-2579
Practice Address - Street 1:3650 E. SOUTH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-633-2204
Practice Address - Fax:562-633-2579
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG76279207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G762790Medicaid
CA00G762790Medicaid
CAH74603Medicare UPIN