Provider Demographics
NPI:1316290794
Name:LORENZO E TIZON MD
Entity type:Organization
Organization Name:LORENZO E TIZON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:TIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-877-3756
Mailing Address - Street 1:433 N 4TH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4311
Mailing Address - Country:US
Mailing Address - Phone:323-877-3256
Mailing Address - Fax:
Practice Address - Street 1:433 N 4TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4311
Practice Address - Country:US
Practice Address - Phone:323-877-3256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40185OtherCAL MB