Provider Demographics
NPI:1215075833
Name:EUSTAQUIO-STOVER, LIZEL LUCIA (LAC)
Entity type:Individual
Prefix:MRS
First Name:LIZEL
Middle Name:LUCIA
Last Name:EUSTAQUIO-STOVER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:LIZEL
Other - Middle Name:
Other - Last Name:STOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1135 WALT WHITMAN RD
Mailing Address - Street 2:#27A
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2826
Mailing Address - Country:US
Mailing Address - Phone:631-683-4796
Mailing Address - Fax:
Practice Address - Street 1:1135 WALT WHITMAN ROAD
Practice Address - Street 2:#27A
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:631-683-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003446171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist