Healthcare Provider Details

I. General information

NPI: 1982416541
Provider Name (Legal Business Name): ELDA LAZARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 YALE ST. UNIT 1
SANTA MONICA CA
90403-4717
US

IV. Provider business mailing address

1150 YALE ST STE 1
SANTA MONICA CA
90403-4772
US

V. Phone/Fax

Practice location:
  • Phone: 310-405-4444
  • Fax:
Mailing address:
  • Phone: 310-405-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number66829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: