Healthcare Provider Details

I. General information

NPI: 1396799532
Provider Name (Legal Business Name): KNEF V LIZASO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KNEF V. LIZASO M.D.

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 7TH STREET DEPARTMENT OF EMERGENCY MEDICINE
SAN PEDRO CA
90732-3505
US

IV. Provider business mailing address

1300 W 7TH STREET ATTN: MEDICAL STAFF OFFICE
SAN PEDRO CA
90732-3505
US

V. Phone/Fax

Practice location:
  • Phone: 310-514-5350
  • Fax:
Mailing address:
  • Phone: 310-514-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA69779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: