Provider Demographics
NPI:1508012584
Name:YANNUZZI, LIZA (MSPT)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:YANNUZZI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0056
Mailing Address - Country:US
Mailing Address - Phone:858-456-2114
Mailing Address - Fax:
Practice Address - Street 1:737 PEARL ST
Practice Address - Street 2:SUITE 108
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0056
Practice Address - Country:US
Practice Address - Phone:858-456-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34118282N00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No282N00000XHospitalsGeneral Acute Care Hospital