Healthcare Provider Details

I. General information

NPI: 1679845408
Provider Name (Legal Business Name): LUZ CAYLAN LAZARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 KENSINGTON RD
OAK BROOK IL
60523-2143
US

IV. Provider business mailing address

1420 KENSINGTON RD
OAK BROOK IL
60523-2143
US

V. Phone/Fax

Practice location:
  • Phone: 630-286-8934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.007432
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: