Provider Demographics
NPI:1417126764
Name:LIZARRAGA, JUAN FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:FERNANDO
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 1:8915 W, VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4809
Mailing Address - Country:US
Mailing Address - Phone:909-824-3389
Mailing Address - Fax:909-824-3389
Practice Address - Street 1:895 W. VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4809
Practice Address - Country:US
Practice Address - Phone:562-654-6855
Practice Address - Fax:562-654-6856
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49181208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice