Provider Demographics
NPI:1194104778
Name:JESSICA A LIZANA DDS, INC
Entity type:Organization
Organization Name:JESSICA A LIZANA DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:LIZANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-477-3539
Mailing Address - Street 1:19524 NORDHOFF ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2430
Mailing Address - Country:US
Mailing Address - Phone:818-477-3539
Mailing Address - Fax:818-477-3540
Practice Address - Street 1:19524 NORDHOFF ST STE 3B
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2430
Practice Address - Country:US
Practice Address - Phone:818-477-3539
Practice Address - Fax:818-477-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55326122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty