Healthcare Provider Details

I. General information

NPI: 1609041201
Provider Name (Legal Business Name): CYNTHIA LYNN LAZZARETTI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 INDIAN DIVIDE ROAD
CAPITAN NM
88316-0813
US

IV. Provider business mailing address

PO BOX 813
CAPITAN NM
88316-0813
US

V. Phone/Fax

Practice location:
  • Phone: 575-354-0686
  • Fax:
Mailing address:
  • Phone: 575-354-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number4903
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: