Individual
LIZAR ACE MANGIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-6364
Mailing address
6964 W OAKDALE AVE, CHICAGO, IL 60634-4839
(773) 727-6131
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/07/2023
Last updated
04/07/2023
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