Healthcare Provider Details

I. General information

NPI: 1942234018
Provider Name (Legal Business Name): LIZA C.G. WU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 TOWN CENTER RD
BOCA RATON FL
33486-1080
US

IV. Provider business mailing address

2930 NW 26TH AVE
BOCA RATON FL
33434-3664
US

V. Phone/Fax

Practice location:
  • Phone: 561-717-3181
  • Fax: 561-717-3191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD429047
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME157381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: