Provider Demographics
NPI:1215680459
Name:MATOS LIZARDO, DORISBEL (MD)
Entity type:Individual
Prefix:DR
First Name:DORISBEL
Middle Name:
Last Name:MATOS LIZARDO
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 1:2940 MALLORY CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1818
Mailing Address - Country:US
Mailing Address - Phone:407-269-8550
Mailing Address - Fax:407-288-1010
Practice Address - Street 1:2940 MALLORY CIR STE 202
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-1818
Practice Address - Country:US
Practice Address - Phone:407-269-8550
Practice Address - Fax:407-288-1010
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1517208D00000X
PR023132208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice