Healthcare Provider Details

I. General information

NPI: 1053510479
Provider Name (Legal Business Name): GABRIEL LAZARIN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE STE 212
GLENDALE AZ
85304-1275
US

IV. Provider business mailing address

5605 W EUGIE AVE STE 212
GLENDALE AZ
85304-1275
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-9700
  • Fax:
Mailing address:
  • Phone: 480-551-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: