Provider Demographics
NPI:1871541086
Name:LIZARDO-MORALES, DIANA E (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:E
Last Name:LIZARDO-MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 HIGHLAND OAKS DR
Mailing Address - Street 2:STE 202
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7106
Mailing Address - Country:US
Mailing Address - Phone:336-760-0070
Mailing Address - Fax:336-760-0017
Practice Address - Street 1:755 HIGHLAND OAKS DR
Practice Address - Street 2:STE 202
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7106
Practice Address - Country:US
Practice Address - Phone:336-760-0070
Practice Address - Fax:336-760-0017
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1389UOtherBLUE CROSS BLUE SHIELD
NC1389UOtherBLUE CROSS BLUE SHIELD