Provider Demographics
NPI:1841252368
Name:LIZARRAGA, ESTEBAN ORLANDO (MD)
Entity type:Individual
Prefix:MR
First Name:ESTEBAN
Middle Name:ORLANDO
Last Name:LIZARRAGA
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:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0955
Mailing Address - Country:US
Mailing Address - Phone:787-839-2946
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA 45
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-839-2946
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7358208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0029399Medicare ID - Type Unspecified
C82607Medicare UPIN