Healthcare Provider Details

I. General information

NPI: 1922329838
Provider Name (Legal Business Name): NOEMI LAZAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 S SIENA ST
SAN DIEGO CA
92114-7266
US

IV. Provider business mailing address

297 S SIENA ST
SAN DIEGO CA
92114-7266
US

V. Phone/Fax

Practice location:
  • Phone: 619-962-1472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number338763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: