Healthcare Provider Details

I. General information

NPI: 1457197154
Provider Name (Legal Business Name): LILIANA VALERIA LAZARIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E 48TH AVE
DENVER CO
80216-2253
US

IV. Provider business mailing address

8300 BLUFF SPRINGS RD APT 831
AUSTIN TX
78744-6874
US

V. Phone/Fax

Practice location:
  • Phone: 303-458-5302
  • Fax:
Mailing address:
  • Phone: 210-501-8941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number002026976
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: