MEDICARE: DR. ANN K. LANZEROTTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	G17197	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G17197	OTHER	CA	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1104227826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN K. LANZEROTTI M.D.

Provider Business Mailing Address
First Line	:	3009 CLAY ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1623
Country	:	US
Telephone Number	:	415-931-7661
Fax Number	:	415-931-7661

Provider Business Practice Location Address
First Line	:	3009 CLAY ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1623
Country	:	US
Telephone Number	:	415-931-7661
Fax Number	:	415-931-7661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	09/12/2014

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