Provider Demographics
NPI:1811334261
Name:CAPISTRANO, LIZA DORADO (RN)
Entity type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:DORADO
Last Name:CAPISTRANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422-C ARDEN ST. GOODWILL 3 SUBD. BRGY. SAN ANTONIO SUCA
Mailing Address - Street 2:
Mailing Address - City:PARANAQUE
Mailing Address - State:MANILA
Mailing Address - Zip Code:1700
Mailing Address - Country:PH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:58 HOWCROFT RD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1813
Practice Address - Country:US
Practice Address - Phone:201-250-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602959-1163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical