Healthcare Provider Details

I. General information

NPI: 1992588396
Provider Name (Legal Business Name): LAURA LAZORKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12183 LOCKSLEY LN STE 103
AUBURN CA
95602-2050
US

IV. Provider business mailing address

406 SUNRISE AVE # 105
ROSEVILLE CA
95661-4106
US

V. Phone/Fax

Practice location:
  • Phone: 916-751-0185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1519580823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: