Healthcare Provider Details

I. General information

NPI: 1750360871
Provider Name (Legal Business Name): ESTHER LOU LAZO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER (SB TL-TMC)
HONOLULU HI
96859-5000
US

IV. Provider business mailing address

92-1471 ALIINUI DR #C
KAPOLEI HI
96707-2246
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8219
  • Fax: 808-433-8217
Mailing address:
  • Phone: 808-677-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: