Healthcare Provider Details

I. General information

NPI: 1033464110
Provider Name (Legal Business Name): CYNTHIA CHEN LAZZARO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 WESTCLIFF DR SUITE 100
NEWPORT BEACH CA
92660-5524
US

IV. Provider business mailing address

1617 WESTCLIFF DR SUITE 100
NEWPORT BEACH CA
92660-5524
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-4111
  • Fax:
Mailing address:
  • Phone: 949-515-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20A12781
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5101020094
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: