| Liza D Chavez, Md., Inc | |
|
3650 E. South St Suite 308 Lakewood CA 90712-1405 | |
| (562) 633-2204 | |
| (562) 633-2579 |
| Full Name | Liza D Chavez, Md., Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3650 E. South St, Lakewood, California |
| Authorized Official Name and Position | Liza D Chavez (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5626332204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liza D Chavez, Md., Inc Po Box 14642 Long Beach CA 90853-4642 Ph: (562) 633-2204 | Liza D Chavez, Md., Inc 3650 E. South St Suite 308 Lakewood CA 90712-1405 Ph: (562) 633-2204 |
| NPI Number | 1710074257 |
|---|---|
| Provider Enumeration Date | 10/06/2006 |
| Last Update Date | 09/29/2011 |
| Medicare PECOS PAC ID | 3577711027 |
|---|---|
| Medicare Enrollment ID | O20120907000334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710074257 | NPI | - | NPPES |
| 00G762790 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | G76279 (California) | Primary |
| Provider Name | Liza D Chavez |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1316038045 PECOS PAC ID: 5890608707 Enrollment ID: I20031106000840 |
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