Provider Demographics
NPI:1497936322
Name:LABOY, LIZZETTE
Entity Type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:LABOY
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:HC 5 BOX 13364
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9513
Mailing Address - Country:US
Mailing Address - Phone:787-371-7277
Mailing Address - Fax:787-837-8710
Practice Address - Street 1:CARRETERA 149 15M 64.7
Practice Address - Street 2:BO GUAYABLA SECTOR TOCADILLO
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-371-7277
Practice Address - Fax:787-837-8710
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 5013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059587Medicare PIN