Healthcare Provider Details

I. General information

NPI: 1306970587
Provider Name (Legal Business Name): YVETTE DENISE LIZARDI LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 W ACADEMY AVE
ANAHEIM CA
92804-2038
US

IV. Provider business mailing address

2959 W ACADEMY AVE
ANAHEIM CA
92804-2038
US

V. Phone/Fax

Practice location:
  • Phone: 714-821-4993
  • Fax:
Mailing address:
  • Phone: 714-821-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT33056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: