Healthcare Provider Details

I. General information

NPI: 1174870968
Provider Name (Legal Business Name): LIZIANETTE GILBES ARROYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OSWEGO ST
SPRINGFIELD MA
01105-2165
US

IV. Provider business mailing address

PO BOX 2557
LAS VEGAS NV
89125-2557
US

V. Phone/Fax

Practice location:
  • Phone: 702-742-4529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: