Healthcare Provider Details

I. General information

NPI: 1598981359
Provider Name (Legal Business Name): DR. LAURIE LAZAROU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S WESTLAKE BLVD STE 131
WESTLAKE VILLAGE CA
91361-1932
US

IV. Provider business mailing address

1240 S WESTLAKE BLVD STE 131
WESTLAKE VILLAGE CA
91361-1932
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-3772
  • Fax: 805-494-3197
Mailing address:
  • Phone: 805-494-3772
  • Fax: 805-494-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number49130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: