Healthcare Provider Details

I. General information

NPI: 1730948498
Provider Name (Legal Business Name): MAELA ROBYNE LAZARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD BLDG 500
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

99-699 KAHILINAI PL # 4A
AIEA HI
96701-3595
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: