Healthcare Provider Details

I. General information

NPI: 1396400529
Provider Name (Legal Business Name): LIZARDO QUALITY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7726 WINEGARD RD STE 26
PINE CASTLE FL
32809-7147
US

IV. Provider business mailing address

4252 PERSHING POINTE PL APT 8
ORLANDO FL
32822-4063
US

V. Phone/Fax

Practice location:
  • Phone: 407-863-0778
  • Fax: 407-863-0778
Mailing address:
  • Phone: 407-714-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JOHANNY LIZARDO
Title or Position: CLINICAL NURSE SPECIALIST
Credential: CNS
Phone: 407-714-5684