Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 20A6147 | CA |
Y | 111NI0900X | Internist | 20A6147 | CA |
N | 207U00000X | Nuclear Medicine Specialist | 20A6147 | CA |
NPI | 1699855841 |
---|---|
Provider Name | Paul E Lizotte |
First Address | Oceanside, CA 92058-1844 |
Second Address | Temecula, CA 92592-4841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 26/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CA127512 | MEDICARE PTAN (01) | CA |