Provider Demographics
NPI:1306472410
Name:LIZAOLA, CASSANDRA (RADT-1)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:LIZAOLA
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:LEBEC
Mailing Address - State:CA
Mailing Address - Zip Code:93243-1534
Mailing Address - Country:US
Mailing Address - Phone:661-231-5413
Mailing Address - Fax:
Practice Address - Street 1:30500 ARRASTRE CANYON RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-2160
Practice Address - Country:US
Practice Address - Phone:661-223-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1317730818374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician