Healthcare Provider Details

I. General information

NPI: 1891341517
Provider Name (Legal Business Name): KTLENNE LEHI LAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S VICTORIA AVE
VENTURA CA
93009-0001
US

IV. Provider business mailing address

PO BOX 8132
OXNARD CA
93031-8132
US

V. Phone/Fax

Practice location:
  • Phone: 805-654-9511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR215966
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: