Healthcare Provider Details

I. General information

NPI: 1982141578
Provider Name (Legal Business Name): YANINA LAZO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16624 SUGAR LN
FONTANA CA
92337-7626
US

IV. Provider business mailing address

16624 SUGAR LN
FONTANA CA
92337-7626
US

V. Phone/Fax

Practice location:
  • Phone: 909-232-2503
  • Fax:
Mailing address:
  • Phone: 909-232-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN237743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: