Individual
AGUSTIN LIZAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 W. BRUNO ST, LOS ANGELES, CA 90012
(323) 526-1254
Mailing address
2677 MOSS AVE #7, LOS ANGELES, CA 90065
(323) 526-1254
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/29/2012
Last updated
08/30/2012
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