Healthcare Provider Details

I. General information

NPI: 1831693068
Provider Name (Legal Business Name): DANIEL VASCO LAZZARESCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 5
SAN FRANCISCO CA
94158-2545
US

IV. Provider business mailing address

460 HIDDEN ACRES RD
HEALDSBURG CA
95448-4629
US

V. Phone/Fax

Practice location:
  • Phone: 707-293-4974
  • Fax:
Mailing address:
  • Phone: 707-293-4974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA166562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: