Healthcare Provider Details

I. General information

NPI: 1982750121
Provider Name (Legal Business Name): ALBERT WILLIAM LIZARRARAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 GENESEE AVE SUITE C
LA JOLLA CA
92037-1210
US

IV. Provider business mailing address

31561 TABLE ROCK DR #309
LAGUNA BEACH CA
92651-8329
US

V. Phone/Fax

Practice location:
  • Phone: 858-643-5650
  • Fax: 858-643-5660
Mailing address:
  • Phone: 949-499-5131
  • Fax: 949-499-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG11341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: