Organization
YBL PLLC
Active
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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