Healthcare Provider Details

I. General information

NPI: 1710490578
Provider Name (Legal Business Name): RAMONA LAZAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4737 EL CAMINO AVE
CARMICHAEL CA
95608-4938
US

IV. Provider business mailing address

4737 EL CAMINO AVE
CARMICHAEL CA
95608-4938
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-3473
  • Fax: 916-487-3483
Mailing address:
  • Phone: 916-487-3473
  • Fax: 916-487-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT294012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: