Healthcare Provider Details

I. General information

NPI: 1982807749
Provider Name (Legal Business Name): ALICE LAZARESCU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6009 W PARKER RD STE 149 PMB 310
PLANO TX
75093-8121
US

IV. Provider business mailing address

6009 W PARKER RD STE 149 PMB 310
PLANO TX
75093-8121
US

V. Phone/Fax

Practice location:
  • Phone: 972-250-2023
  • Fax: 972-250-2086
Mailing address:
  • Phone: 972-250-2023
  • Fax: 972-250-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL5427
License Number StateTX

VIII. Authorized Official

Name: DENISE L STEICHEN
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 972-250-2023