Provider Demographics
NPI:1497320709
Name:AGUAS LIZANO, JOHN STEVEN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEVEN
Last Name:AGUAS LIZANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 OTIS AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1150
Mailing Address - Country:US
Mailing Address - Phone:323-317-3936
Mailing Address - Fax:
Practice Address - Street 1:6310 OTIS AVE APT C
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1150
Practice Address - Country:US
Practice Address - Phone:323-317-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician