Healthcare Provider Details

I. General information

NPI: 1639490634
Provider Name (Legal Business Name): LAZARUS ANESTHESIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
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 Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number556814
License Number StateCA

VIII. Authorized Official

Name: MRS. ELIZABETH LAZARUS
Title or Position: PRESIDENT
Credential: C.R.N.A
Phone: 619-246-8420