MEDICARE: LIZA D CHAVEZ, MD., INC

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	207RI0200X	Infectious Disease Physician	G76279	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1710074257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIZA D CHAVEZ, MD., INC

Provider Business Mailing Address
First Line	:	PO BOX 14642
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90853-4642
Country	:	US
Telephone Number	:	562-633-2204
Fax Number	:	562-633-2579

Provider Business Practice Location Address
First Line	:	3650 E. SOUTH ST
Second Line	:	SUITE 308
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1405
Country	:	US
Telephone Number	:	562-633-2204
Fax Number	:	562-633-2579

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. LIZA D CHAVEZ
Credential	:	M.D.
Telephone Number	:	562-633-2204

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	09/29/2011

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