Healthcare Provider Details

I. General information

NPI: 1780887083
Provider Name (Legal Business Name): MR. BERNY ESTEEV LAZARENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 CAROB WAY APT 2
MONTEBELLO CA
90640-5828
US

IV. Provider business mailing address

3881 S. WESTERN
LOS ANGELES CA
90062
US

V. Phone/Fax

Practice location:
  • Phone: 323-253-6363
  • Fax:
Mailing address:
  • Phone: 323-290-4375
  • Fax: 323-293-8159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: