Healthcare Provider Details

I. General information

NPI: 1033797584
Provider Name (Legal Business Name): ANDREA MARGARITA LIZARAZO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21B ARTS CENTER CT
AVON CT
06001-3709
US

IV. Provider business mailing address

21B ARTS CENTER CT
AVON CT
06001-3709
US

V. Phone/Fax

Practice location:
  • Phone: 860-678-9400
  • Fax:
Mailing address:
  • Phone: 860-678-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number79352
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: