MEDICARE: DR. ELEANOR LAZO 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	207L00000X	Anesthesiology Physician	A50026	CA

General Provider Information

NPI Number	:	1336131317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELEANOR LAZO M.D.

Provider Business Mailing Address
First Line	:	610 ANSEL RD
Second Line	:	#5
City	:	BURLINGAME
State	:	CA
Zip	:	94010-4069
Country	:	US
Telephone Number	:	650-343-9746
Fax Number	:	650-343-9746

Provider Business Practice Location Address
First Line	:	901 CAMPUS DR
Second Line	:	#101
City	:	DALY CITY
State	:	CA
Zip	:	94015-4900
Country	:	US
Telephone Number	:	650-991-2000
Fax Number	:

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/09/2007

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