Healthcare Provider Details

I. General information

NPI: 1376742072
Provider Name (Legal Business Name): SHARONA C LAZAR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12648 MARTHA ST
VALLEY VILLAGE CA
91607-1514
US

IV. Provider business mailing address

12648 MARTHA ST
VALLEY VILLAGE CA
91607-1514
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-9399
  • Fax:
Mailing address:
  • Phone: 818-755-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number881194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: