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Organization

YBL PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. VINCENT V LIZAMA M.D. (MANAGER)
16717775259
Entity
Organization

Contact information

Practice address
643 CHALAN SAN ANTONIO, STE 109, TAMUNING, GU 96913-3644
(671) 648-6390
(671) 648-6398
Mailing address
643 CHALAN SAN ANTONIO, STE 109, TAMUNING, GU 96913-3644
(671) 648-6390
(671) 648-6398

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M001519
GU
2085U0001X
Diagnostic Ultrasound Physician
M001519
GU

Other

Enumeration date
03/01/2010
Last updated
09/15/2011
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