Provider Demographics
NPI:1356310072
Name:LIZARRAGA, GABRIEL MARCEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:MARCEL
Last Name:LIZARRAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1200
Mailing Address - Country:US
Mailing Address - Phone:305-500-2009
Mailing Address - Fax:305-500-2145
Practice Address - Street 1:11000 S.W. 211 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189
Practice Address - Country:US
Practice Address - Phone:305-254-1500
Practice Address - Fax:305-254-1518
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 86112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI11294Medicare UPIN
FLU2439ZMedicare NSC