Provider Demographics
NPI:1518604164
Name:LIZARRAGA LANDEROS, YELITZA
Entity type:Individual
Prefix:
First Name:YELITZA
Middle Name:
Last Name:LIZARRAGA LANDEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 KINGS COUNTY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5954
Mailing Address - Country:US
Mailing Address - Phone:559-754-3128
Mailing Address - Fax:
Practice Address - Street 1:530 KINGS COUNTY DR STE 106
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5954
Practice Address - Country:US
Practice Address - Phone:559-754-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760431670OtherFAMILY AND PEER SPECIALIST