MEDICARE: MARIA CECILLE TADIAR LIZARDO SLPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SPA499	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SPA499	OTHER	CA	SLPAB

General Provider Information

NPI Number	:	1033404942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA CECILLE TADIAR LIZARDO SLPA

Provider Business Mailing Address
First Line	:	433 N 4TH ST STE 101A
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4313
Country	:	US
Telephone Number	:	909-576-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 N 4TH ST STE 101A
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4313
Country	:	US
Telephone Number	:	909-576-1869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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Directions to “ MARIA CECILLE TADIAR LIZARDO SLPA” Practice Location

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