Healthcare Provider Details

I. General information

NPI: 1154599785
Provider Name (Legal Business Name): JOHN LAZAR FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2008
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N SEPULVEDA BLVD
MANHATTAN BEACH CA
90266-2730
US

IV. Provider business mailing address

15111 FREEMAN AVE UNIT 24
LAWNDALE CA
90260-2159
US

V. Phone/Fax

Practice location:
  • Phone: 310-546-3481
  • Fax:
Mailing address:
  • Phone: 310-484-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: