Provider Demographics
NPI:1407840960
Name:DIMARANAN, LIZA F (O D)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:F
Last Name:DIMARANAN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 PASSONS BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2800
Mailing Address - Country:US
Mailing Address - Phone:562-948-1927
Mailing Address - Fax:562-948-4488
Practice Address - Street 1:5026 PASSONS BLVD
Practice Address - Street 2:STE B
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2800
Practice Address - Country:US
Practice Address - Phone:562-948-1927
Practice Address - Fax:562-948-4488
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2008-09-10
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CA11873T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0118730Medicaid
CAOP11873Medicare PIN
CAU95440Medicare UPIN
CASD0118730Medicaid