MEDICARE: ISRAEL LIZAMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	VN 227726	CA

General Provider Information

NPI Number	:	1407001944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISRAEL LIZAMA

Provider Business Mailing Address
First Line	:	2500 N PALM CANYON DR # A1-A4
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-1868
Country	:	US
Telephone Number	:	760-424-5602
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 N PALM CANYON DR # A1-A4
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-1868
Country	:	US
Telephone Number	:	760-424-5602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	03/23/2023

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