Healthcare Provider Details

I. General information

NPI: 1699855841
Provider Name (Legal Business Name): PAUL EDWARD LIZOTTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NORTH EL CAMINO REAL SUITE A 115 NORTH EL CAMINO REAL SUITE A
OCEANSIDE CA
92058-1844
US

IV. Provider business mailing address

115 NORTH EL CAMINO REAL SUITE A
OCEANSIDE CA
92058-1844
US

V. Phone/Fax

Practice location:
  • Phone: 760-330-5055
  • Fax: 760-542-2026
Mailing address:
  • Phone: 760-330-5055
  • Fax: 760-542-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number20A6147
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6147
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0000020A6147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: