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General NPI Number Information
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NPI Number | 1710074257
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Entity Type | Organization
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Legal Business Name | LIZA D CHAVEZ, MD., INC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 3650 E. SOUTH ST SUITE 308
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City | LAKEWOOD
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State | CA
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Zip | 90712-1405
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Country | US
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Telephone | 562-633-2204
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Fax | 562-633-2579
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Provider Business Mailing Address
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Address Line | PO BOX 14642
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City | LONG BEACH
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State | CA
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Zip | 90853-4642
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Country | US
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Telephone | 562-633-2204
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Fax | 562-633-2579
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LIZA D CHAVEZ
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Credential | M.D.
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Telephone | 562-633-2204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | G76279
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License Number State | CA
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