Healthcare Provider Details

I. General information

NPI: 1518148907
Provider Name (Legal Business Name): GERALDINE LAZAR RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CENTER AVE SUITE 150
MARTINEZ CA
94553-4633
US

IV. Provider business mailing address

595 CENTER AVE SUITE 150
MARTINEZ CA
94553-4633
US

V. Phone/Fax

Practice location:
  • Phone: 510-231-8575
  • Fax: 925-313-6188
Mailing address:
  • Phone: 510-231-8575
  • Fax: 925-313-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number144886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: