Healthcare Provider Details

I. General information

NPI: 1912470006
Provider Name (Legal Business Name): SELENA MARIA LAZZAROTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OLYMPIC BLVD
WALNUT CREEK CA
94596-5096
US

IV. Provider business mailing address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

V. Phone/Fax

Practice location:
  • Phone: 925-433-0990
  • Fax:
Mailing address:
  • Phone: 707-784-2080
  • Fax: 707-425-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: