Healthcare Provider Details

I. General information

NPI: 1174634802
Provider Name (Legal Business Name): SEGUNDO LUIS LIZARDO-GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 JAMES ST STE B
WESLACO TX
78596-6654
US

IV. Provider business mailing address

1010 JAMES ST STE B
WESLACO TX
78596-6654
US

V. Phone/Fax

Practice location:
  • Phone: 956-968-1621
  • Fax: 956-447-8626
Mailing address:
  • Phone: 956-968-1621
  • Fax: 956-447-8626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM4302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: