Healthcare Provider Details

I. General information

NPI: 1124663661
Provider Name (Legal Business Name): PRISCILLA LAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

IV. Provider business mailing address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-4559
  • Fax:
Mailing address:
  • Phone: 310-373-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: