Healthcare Provider Details

I. General information

NPI: 1700642311
Provider Name (Legal Business Name): CARL VIRGIL BELAN LAZARO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N BELLFLOWER BLVD
LONG BEACH CA
90840-0004
US

IV. Provider business mailing address

3941A BRAYTON AVE
LONG BEACH CA
90807-3707
US

V. Phone/Fax

Practice location:
  • Phone: 562-676-8028
  • Fax:
Mailing address:
  • Phone: 562-676-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: