Healthcare Provider Details

I. General information

NPI: 1861769341
Provider Name (Legal Business Name): GARY STEVEN LAZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 ALDEA AVE
ENCINO CA
91316-2646
US

IV. Provider business mailing address

5342 ALDEA AVE
ENCINO CA
91316-2646
US

V. Phone/Fax

Practice location:
  • Phone: 818-990-9572
  • Fax:
Mailing address:
  • Phone: 818-990-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG034411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: