Healthcare Provider Details

I. General information

NPI: 1205460276
Provider Name (Legal Business Name): FRANCHESCA LAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 CHICAGO AVE STE 203
RIVERSIDE CA
92507-2209
US

IV. Provider business mailing address

18726 S WESTERN AVE STE 408
GARDENA CA
90248-3858
US

V. Phone/Fax

Practice location:
  • Phone: 951-880-0750
  • Fax:
Mailing address:
  • Phone: 310-856-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00006502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: