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General NPI Number Information
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NPI Number | 1083849574
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Entity Type | Individual
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Provider Name | DWAYNE LIZAR M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 1740 LA COSTA MEADOWS DR SUITE 144
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City | SAN MARCOS
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State | CA
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Zip | 92078-5199
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Country | US
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Telephone | 951-970-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 39873 MOUNT BLANC AVE
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City | MURRIETA
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State | CA
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Zip | 92562-4797
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Country | US
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Telephone | 951-970-1194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AU 648
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP 4188
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License Number State | CA
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