Healthcare Provider Details

I. General information

NPI: 1477088979
Provider Name (Legal Business Name): THOMAS ADRIANO MCINNES LAZZARINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2017
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 FIFTH AVE STE 330
SAN DIEGO CA
92103-3107
US

IV. Provider business mailing address

12630 MONTE VISTA RD STE 104
POWAY CA
92064-2526
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-1911
  • Fax: 858-451-0566
Mailing address:
  • Phone: 858-451-1911
  • Fax: 858-451-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA191729
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME150161
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA191729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: