Healthcare Provider Details

I. General information

NPI: 1649555319
Provider Name (Legal Business Name): MARIA CAMELA LAZO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA CAMELA TAYOUN BSN, RN

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 11/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST GROUND SILVERSTEIN BLDG
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST GROUND SILVERSTEIN BLDG
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-6698
  • Fax:
Mailing address:
  • Phone: 215-662-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011298
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: