Provider Demographics
NPI:1497488787
Name:MATOS ROJAS, LIZMARIE
Entity Type:Individual
Prefix:DR
First Name:LIZMARIE
Middle Name:
Last Name:MATOS ROJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CALLE VENUS
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-5123
Mailing Address - Country:US
Mailing Address - Phone:787-246-7908
Mailing Address - Fax:
Practice Address - Street 1:72 CALLE VENUS
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-5123
Practice Address - Country:US
Practice Address - Phone:787-246-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023402208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice