MEDICARE: ADELWISA VIADO LIZADA MD

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	2084P0800X	Psychiatry Physician	10913	NV

General Provider Information

NPI Number	:	1164523296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELWISA VIADO LIZADA MD

Provider Business Mailing Address
First Line	:	7996 DUTCH VILLAS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6287
Country	:	US
Telephone Number	:	702-897-9470
Fax Number	:

Provider Business Practice Location Address
First Line	:	6161 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1126
Country	:	US
Telephone Number	:	702-486-6045
Fax Number	:	702-486-0411

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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