Healthcare Provider Details

I. General information

NPI: 1770426967
Provider Name (Legal Business Name): AELITA LAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22048 SHERMAN WAY STE 313
CANOGA PARK CA
91303-3014
US

IV. Provider business mailing address

22048 SHERMAN WAY STE 313
CANOGA PARK CA
91303-3014
US

V. Phone/Fax

Practice location:
  • Phone: 818-602-2737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: