Healthcare Provider Details

I. General information

NPI: 1437436698
Provider Name (Legal Business Name): MS. ELEANOR LAZAROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

6749 NEPETA WAY
CARLSBAD CA
92011-3326
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-1700
  • Fax:
Mailing address:
  • Phone: 858-822-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 18970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: