Provider Demographics
NPI:1639121486
Name:LIZARRAGA, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
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 1:3441 MARYSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-4512
Mailing Address - Country:US
Mailing Address - Phone:916-563-7230
Mailing Address - Fax:916-563-7229
Practice Address - Street 1:3441 MARYSVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-4512
Practice Address - Country:US
Practice Address - Phone:916-563-7230
Practice Address - Fax:916-563-7229
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46523OtherCA MEDICAL LICENSE
CAFC230YMedicare PIN
CAFC230ZMedicare PIN
CAFC230XMedicare PIN