Healthcare Provider Details

I. General information

NPI: 1437843794
Provider Name (Legal Business Name): JENNIFER PATRICIA LAZO-PACHECO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 CENTRE AVE
PITTSBURGH PA
15232-1304
US

IV. Provider business mailing address

1233 ORANGEWOOD AVE
PITTSBURGH PA
15216-3813
US

V. Phone/Fax

Practice location:
  • Phone: 412-748-5772
  • Fax:
Mailing address:
  • Phone: 412-495-2906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064663
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: