Healthcare Provider Details

I. General information

NPI: 1861276263
Provider Name (Legal Business Name): VICTORIA MARIE LAZO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6171 W CHARLESTON BLVD
LAS VEGAS NV
89146-1126
US

IV. Provider business mailing address

123 BERNERI DR
LAS VEGAS NV
89138-4642
US

V. Phone/Fax

Practice location:
  • Phone: 516-808-6037
  • Fax:
Mailing address:
  • Phone: 516-808-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number854573
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number812210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: