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NPI Code Detail

MEDICARE: LIZA MACATULA

MEDICARE:   LIZA  MACATULA
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
1163W00000XRegistered Nurse492782CA
2363L00000XNurse Practitioner13154CA

General Provider Information

NPI Number : 1417494014
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIZA MACATULA
Provider Business Mailing Address
First Line : 17386 TABLERO PL
Second Line :
City : SAN DIEGO
State : CA
Zip : 92127-1313
Country : US
Telephone Number : 858-613-1474
Fax Number :
Provider Business Practice Location Address
First Line : 5530 OVERLAND AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1260
Country : US
Telephone Number : 858-974-5960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2017
Last Update Date : 01/21/2017

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Directions to “ LIZA MACATULA ” Practice Location

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