Healthcare Provider Details

I. General information

NPI: 1033743349
Provider Name (Legal Business Name): ANDREA M LAZARIN LAC, MSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122A SUTTER ST
SAN FRANCISCO CA
94109-5608
US

IV. Provider business mailing address

753 WALKER AVE
OAKLAND CA
94610-2736
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-6124
  • Fax:
Mailing address:
  • Phone: 505-238-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: