MEDICARE: LILIA IVETH LIZANO M.D.

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	207V00000X	Obstetrics & Gynecology Physician	G63124	CA

General Provider Information

NPI Number	:	1588622146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIA IVETH LIZANO M.D.

Provider Business Mailing Address
First Line	:	500 ALFRED NOBEL DR
Second Line	:	SUITE 200
City	:	HERCULES
State	:	CA
Zip	:	94547-1838
Country	:	US
Telephone Number	:	510-724-4435
Fax Number	:	510-724-4686

Provider Business Practice Location Address
First Line	:	500 ALFRED NOBEL DR
Second Line	:	SUITE 200
City	:	HERCULES
State	:	CA
Zip	:	94547-1838
Country	:	US
Telephone Number	:	510-724-4435
Fax Number	:	510-724-4686

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	06/10/2010

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