MEDICARE: LAZARUS ANESTHESIA, INC.

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	367500000X	Certified Registered Nurse Anesthetist	556814	CA

General Provider Information

NPI Number	:	1639490634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAZARUS ANESTHESIA, INC.

Provider Business Mailing Address
First Line	:	3516 WOODLAND WAY
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-2560
Country	:	US
Telephone Number	:	619-246-8420
Fax Number	:	760-994-1205

Provider Business Practice Location Address
First Line	:	3516 WOODLAND WAY
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-2560
Country	:	US
Telephone Number	:	619-246-8420
Fax Number	:	760-994-1205

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ELIZABETH LAZARUS
Credential	:	C.R.N.A
Telephone Number	:	619-246-8420

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/14/2010

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