Provider Demographics
NPI:1184962565
Name:DIAZ-QUEROL, LIZ (MD)
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:
Last Name:DIAZ-QUEROL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZMER
Other - Middle Name:
Other - Last Name:DIAZ DE GIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 E GONZALES RD
Mailing Address - Street 2:OXNARD MEDICAL BUILDING, 2ND FL
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0619
Mailing Address - Country:US
Mailing Address - Phone:188-851-5350
Mailing Address - Fax:
Practice Address - Street 1:2200 E GONZALES RD
Practice Address - Street 2:OXNARD II MEDICAL OFFICE BUILDING
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0619
Practice Address - Country:US
Practice Address - Phone:888-515-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-20
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA131242OtherCALIFORNIA LICENSE