Healthcare Provider Details

I. General information

NPI: 1508153842
Provider Name (Legal Business Name): DIONISIO DUMBRIQUE LAZARO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18575 EAST GALE AVENUE SUITE 155
CITY OF INDUSTRY CA
91748-1340
US

IV. Provider business mailing address

18575 EAST GALE AVENUE SUITE 155
CITY OF INDUSTRY CA
91748-1340
US

V. Phone/Fax

Practice location:
  • Phone: 626-581-8960
  • Fax: 626-581-8536
Mailing address:
  • Phone: 626-581-8960
  • Fax: 626-581-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA48512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA48512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: