Provider Demographics
NPI:1114992328
Name:IZABAL, LORI J (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:IZABAL
Suffix:
Gender:
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1401 AVOCADO AVE STE 608
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8719
Mailing Address - Country:US
Mailing Address - Phone:949-640-4455
Mailing Address - Fax:949-640-4456
Practice Address - Street 1:1401 AVOCADO AVE STE 608
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8719
Practice Address - Country:US
Practice Address - Phone:949-640-4455
Practice Address - Fax:949-640-4456
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA61528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA61528BMedicare PIN