Healthcare Provider Details

I. General information

NPI: 1962366914
Provider Name (Legal Business Name): HASSAN LIZARDI CARRANZA CMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 140TH STREET CT E UNIT 34
PUYALLUP WA
98374-4929
US

IV. Provider business mailing address

10511 140TH STREET CT E UNIT 34
PUYALLUP WA
98374-4929
US

V. Phone/Fax

Practice location:
  • Phone: 253-306-3017
  • Fax:
Mailing address:
  • Phone: 253-306-3017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: