Healthcare Provider Details

I. General information

NPI: 1639430986
Provider Name (Legal Business Name): LIZA FLORY PARIDO LAQUIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

BOX 100109
GAINESVILLE FL
32610-0286
US

V. Phone/Fax

Practice location:
  • Phone: 727-365-4333
  • Fax:
Mailing address:
  • Phone: 352-265-0761
  • Fax: 352-265-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME151405
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: