Healthcare Provider Details

I. General information

NPI: 1275203481
Provider Name (Legal Business Name): AZUCENA RUBI LAZO BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 W 7TH ST
LOS ANGELES CA
90057-3801
US

IV. Provider business mailing address

2523 W 7TH ST
LOS ANGELES CA
90057-3801
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1557
  • Fax:
Mailing address:
  • Phone: 213-480-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: