Provider Demographics
NPI:1760676548
Name:FAMADOR, MA. LIZA ANN FLORES (MD)
Entity Type:Individual
Prefix:
First Name:MA. LIZA ANN
Middle Name:FLORES
Last Name:FAMADOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 DORIC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2903
Mailing Address - Country:US
Mailing Address - Phone:401-467-9610
Mailing Address - Fax:401-467-9030
Practice Address - Street 1:191 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-7244
Practice Address - Country:US
Practice Address - Phone:401-828-7688
Practice Address - Fax:401-828-2914
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187985207Q00000X
RIMD13039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine