MEDICARE: MR. PAUL EDWARD LIZOTTE DO

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	207U00000X	Nuclear Medicine Physician	20A6147	CA
2	207R00000X	Internal Medicine Physician	20A6147	CA
3	2085R0202X	Diagnostic Radiology Physician	0000020A6147	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA127512	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1699855841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL EDWARD LIZOTTE DO

Provider Business Mailing Address
First Line	:	115 N EL CAMINO REAL STE A
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1844
Country	:	US
Telephone Number	:	760-330-5055
Fax Number	:	760-542-2026

Provider Business Practice Location Address
First Line	:	115 NORTH EL CAMINO REAL SUITE A
Second Line	:	115 NORTH EL CAMINO REAL SUITE A
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1844
Country	:	US
Telephone Number	:	760-330-5055
Fax Number	:	760-542-2026

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/11/2026

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