Provider Demographics
NPI:1013429604
Name:VIZCARDO BULEJE, LIZBETH SUJEY (SA-C)
Entity Type:Individual
Prefix:
First Name:LIZBETH
Middle Name:SUJEY
Last Name:VIZCARDO BULEJE
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ROYAL PALM BLVD APT 310
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5855
Mailing Address - Country:US
Mailing Address - Phone:954-696-8864
Mailing Address - Fax:
Practice Address - Street 1:9000 ROYAL PALM BLVD APT 310
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5855
Practice Address - Country:US
Practice Address - Phone:954-696-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-597246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant