Provider Demographics
NPI:1982884706
Name:ELIZABETH G. LYSTER, M.D., INC.
Entity Type:Organization
Organization Name:ELIZABETH G. LYSTER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:LYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-500-1351
Mailing Address - Street 1:26671 ALISO CREEK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4809
Mailing Address - Country:US
Mailing Address - Phone:949-831-0300
Mailing Address - Fax:949-831-0339
Practice Address - Street 1:26671 ALISO CREEK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4809
Practice Address - Country:US
Practice Address - Phone:949-831-0300
Practice Address - Fax:949-831-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72094207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG72094DMedicare PIN
CAG24875Medicare UPIN
CAW16773Medicare PIN