Healthcare Provider Details

I. General information

NPI: 1568465706
Provider Name (Legal Business Name): ELIZABETH LAZARUS C.R.N.A, R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 WOODLAND WAY
CARLSBAD CA
92008-2560
US

IV. Provider business mailing address

3516 WOODLAND WAY
CARLSBAD CA
92008-2560
US

V. Phone/Fax

Practice location:
  • Phone: 619-246-8420
  • Fax: 760-994-1205
Mailing address:
  • Phone: 619-246-8420
  • Fax: 760-994-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number556814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: