Basic Information
| Provider Information | |||||||||
| NPI: | 1538172358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SISTOZA | ||||||||
| FirstName: | LILYBETH | ||||||||
| MiddleName: | CALINGASAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 162 WESTERN BLVD | ||||||||
| Address2: | APT 901 | ||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969133175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097905071 | ||||||||
| FaxNumber: | 9097905774 | ||||||||
| Practice Location | |||||||||
| Address1: | 17264 FOOTHILL BLVD | ||||||||
| Address2: | STE A B | ||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923359051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094283900 | ||||||||
| FaxNumber: | 9094283903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 02/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A78188 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A781880 | 05 | CA | MEDICAID |