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NPI Code Detail

MEDICARE: MR. JOSE LUIS LIZARDI IV

MEDICARE: MR. JOSE LUIS LIZARDI IV
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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619680295
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE LUIS LIZARDI IV
Provider Business Mailing Address
First Line : 4940 NORTHDALE BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33624-1075
Country : US
Telephone Number : 315-244-0615
Fax Number :
Provider Business Practice Location Address
First Line : 4940 NORTHDALE BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33624-1075
Country : US
Telephone Number : 315-244-0615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2022
Last Update Date : 01/09/2026

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Directions to “ MR. JOSE LUIS LIZARDI IV ” Practice Location

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