Healthcare Provider Details

I. General information

NPI: 1831668292
Provider Name (Legal Business Name): LIZARRAGA MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 W VALLEY BLVD
COLTON CA
92324-2001
US

IV. Provider business mailing address

895 W VALLEY BLVD
COLTON CA
92324-2001
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-3389
  • Fax: 909-824-1087
Mailing address:
  • Phone: 909-824-3389
  • Fax: 909-824-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GINGER JOHNSON
Title or Position: MANAGER
Credential:
Phone: 818-294-2657