Healthcare Provider Details

I. General information

NPI: 1588894737
Provider Name (Legal Business Name): LYDIA LAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR STE 200
LAGUNA HILLS CA
92653-1523
US

IV. Provider business mailing address

4709 CLARK AVE
LONG BEACH CA
90808-1102
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1556
  • Fax:
Mailing address:
  • Phone: 562-673-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: