Provider Demographics
NPI:1124117072
Name:MATOS-LAGO, LIZA LUMARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LIZA
Middle Name:LUMARIE
Last Name:MATOS-LAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J9 PARQ DE LA LUZ
Mailing Address - Street 2:BAIROA PARK
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1217
Mailing Address - Country:US
Mailing Address - Phone:787-384-5723
Mailing Address - Fax:
Practice Address - Street 1:J9 PARQ DE LA LUZ
Practice Address - Street 2:BAIROA PARK
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-1217
Practice Address - Country:US
Practice Address - Phone:787-384-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16649208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice