Healthcare Provider Details

I. General information

NPI: 1851628747
Provider Name (Legal Business Name): ALEXANDRA S LAZO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 N KELLOGG ST
KENNEWICK WA
99336
US

IV. Provider business mailing address

1029 N KELLOGG ST
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-735-9355
  • Fax: 509-783-0259
Mailing address:
  • Phone: 509-735-9355
  • Fax: 509-783-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00024324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: