Provider Demographics
NPI:1851461230
Name:LYSTER, ELIZABETH GUTRECHT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GUTRECHT
Last Name:LYSTER
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:26671 ALISO CREEK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4809
Mailing Address - Country:US
Mailing Address - Phone:949-831-0300
Mailing Address - Fax:949-831-0339
Practice Address - Street 1:26671 ALISO CREEK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4809
Practice Address - Country:US
Practice Address - Phone:949-831-0300
Practice Address - Fax:949-831-0339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG72094207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72094OtherLICENSE
CABG2958330OtherDEA NUMBER
CAG24875Medicare UPIN
CAWG72094DMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CAG72094OtherLICENSE