Healthcare Provider Details

I. General information

NPI: 1194928077
Provider Name (Legal Business Name): SARA LAZZARETTO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S RAYMOND AVE
ALHAMBRA CA
91801-3166
US

IV. Provider business mailing address

1155 E TOPEKA ST
PASADENA CA
91104-1455
US

V. Phone/Fax

Practice location:
  • Phone: 626-458-4707
  • Fax:
Mailing address:
  • Phone: 626-345-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: