Healthcare Provider Details

I. General information

NPI: 1316675762
Provider Name (Legal Business Name): LAZULI SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 AMERICAN BLVD E APT 7
BLOOMINGTON MN
55420-1385
US

IV. Provider business mailing address

671 AMERICAN BLVD E APT 7
BLOOMINGTON MN
55420-1385
US

V. Phone/Fax

Practice location:
  • Phone: 651-347-0043
  • Fax: 651-846-5580
Mailing address:
  • Phone: 651-347-0043
  • Fax: 651-846-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: FADUMO BASHIR ABDISALAN
Title or Position: OWNER
Credential:
Phone: 651-347-0043