Healthcare Provider Details

I. General information

NPI: 1720648264
Provider Name (Legal Business Name): DANIELA LAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18645 HATTERAS ST UNIT 263
TARZANA CA
91356-1874
US

IV. Provider business mailing address

18645 HATTERAS ST UNIT 263
TARZANA CA
91356-1874
US

V. Phone/Fax

Practice location:
  • Phone: 818-457-8792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95011663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: