Healthcare Provider Details

I. General information

NPI: 1942629779
Provider Name (Legal Business Name): LHARA MARIA DE LOS ANGELES SUMARRIVA LEZAMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11668 SHERMAN WAY
LOS ANGELES CA
90074-0001
US

IV. Provider business mailing address

11668 SHERMAN WAY
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA144625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: