Healthcare Provider Details

I. General information

NPI: 1356310072
Provider Name (Legal Business Name): GABRIEL MARCEL LIZARRAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 S.W. 211 ST
MIAMI FL
33189
US

IV. Provider business mailing address

7200 CORPORATE CENTER DR SUITE 600
MIAMI FL
33126-1200
US

V. Phone/Fax

Practice location:
  • Phone: 305-254-1500
  • Fax: 305-254-1518
Mailing address:
  • Phone: 305-500-2009
  • Fax: 305-500-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 86112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: