Provider Demographics
NPI:1972584100
Name:ALQUEZA, ELIZABETH LANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LANE
Last Name:ALQUEZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:33 KENDALL ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7566
Mailing Address - Country:US
Mailing Address - Phone:617-632-9716
Mailing Address - Fax:617-632-1065
Practice Address - Street 1:110 FRANCIS ST
Practice Address - Street 2:SUITE 8E
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-9716
Practice Address - Fax:617-632-1065
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102831363AM0700X
MA2112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3699ZMedicare ID - Type Unspecified
FLQ27479Medicare UPIN