Provider Demographics
NPI:1396400529
Name:LIZARDO QUALITY CARE LLC
Entity Type:Organization
Organization Name:LIZARDO QUALITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:CNS
Authorized Official - Phone:407-714-5684
Mailing Address - Street 1:4252 PERSHING POINTE PL APT 8
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4063
Mailing Address - Country:US
Mailing Address - Phone:407-714-5684
Mailing Address - Fax:
Practice Address - Street 1:7726 WINEGARD RD STE 26
Practice Address - Street 2:
Practice Address - City:PINE CASTLE
Practice Address - State:FL
Practice Address - Zip Code:32809-7147
Practice Address - Country:US
Practice Address - Phone:407-863-0778
Practice Address - Fax:407-863-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health