Provider Demographics
NPI:1891059259
Name:LIZARRAGA MENDOZA, KARLO JOHN (MD, MS)
Entity Type:Individual
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First Name:KARLO
Middle Name:JOHN
Last Name:LIZARRAGA MENDOZA
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Gender:M
Credentials:MD, MS
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Mailing Address - Street 1:601 ELMWOOD AVE BOX 278984
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-341-7500
Mailing Address - Fax:585-461-9078
Practice Address - Street 1:919 WESTFALL RD., BUILDING C
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2692
Practice Address - Country:US
Practice Address - Phone:585-341-7500
Practice Address - Fax:585-461-9078
Is Sole Proprietor?:No
Enumeration Date:2012-06-30
Last Update Date:2023-06-30
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Provider Licenses
StateLicense IDTaxonomies
NY2965192084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology