MEDICARE: MADELEIN RAE ELORIAGA LAZARO NP

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	363L00000X	Nurse Practitioner	95035060	CA

General Provider Information

NPI Number	:	1730077280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEIN RAE ELORIAGA LAZARO NP

Provider Business Mailing Address
First Line	:	17040 SHADYMEADOW DR
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-3121
Country	:	US
Telephone Number	:	323-603-7654
Fax Number	:

Provider Business Practice Location Address
First Line	:	17040 SHADYMEADOW DR
Second Line	:
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-3121
Country	:	US
Telephone Number	:	323-603-7654
Fax Number	:

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

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/25/2025

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