Provider Demographics
NPI:1265170302
Name:LIZARDO, OSVALY GREGORIO (MD)
Entity type:Individual
Prefix:DR
First Name:OSVALY
Middle Name:GREGORIO
Last Name:LIZARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. BELLO MONTE CALLE 13 F 21
Mailing Address - Street 2:GUAYNABO PR 00969
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-477-4124
Mailing Address - Fax:
Practice Address - Street 1:URB. BELLO MONTE CALLE 13 F 21
Practice Address - Street 2:GUAYNABO PR 00969
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-477-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23575208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice