Healthcare Provider Details

I. General information

NPI: 1902540180
Provider Name (Legal Business Name): ANA LAZO-JONES MASTERS, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DOUGLAS AVE NW
ROANOKE VA
24012-4611
US

IV. Provider business mailing address

40 DOUGLAS AVE NW
ROANOKE VA
24012-4611
US

V. Phone/Fax

Practice location:
  • Phone: 323-344-9030
  • Fax:
Mailing address:
  • Phone: 132-344-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number083001203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: