Healthcare Provider Details

I. General information

NPI: 1518045822
Provider Name (Legal Business Name): FELICITAS LARDIZABAL LACBAWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE CLEVELAND CLINIC MOLECULAR PATHOLOGY MC:LL2-2
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE CLEVELAND CLINIC MOLECULAR PATHOLOGY MC:LL2-2
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-0761
  • Fax: 216-445-0681
Mailing address:
  • Phone: 216-445-0761
  • Fax: 216-445-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number253903-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number35098505
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number253903-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number253903-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: