Healthcare Provider Details

I. General information

NPI: 1619638087
Provider Name (Legal Business Name): CECILIA DUMLAO LAZAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 WESTWIND DR
BAKERSFIELD CA
93301-3028
US

IV. Provider business mailing address

9817 ALONDRA DR
BAKERSFIELD CA
93311-4575
US

V. Phone/Fax

Practice location:
  • Phone: 661-632-1800
  • Fax:
Mailing address:
  • Phone: 661-563-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95019554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: