Healthcare Provider Details

I. General information

NPI: 1649344193
Provider Name (Legal Business Name): VANIDO C LAZAGA LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY SUITE 817
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

19528 11TH AVE W
LYNNWOOD WA
98036-7160
US

V. Phone/Fax

Practice location:
  • Phone: 206-467-6479
  • Fax: 206-467-2777
Mailing address:
  • Phone: 425-712-1472
  • Fax: 206-467-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00014369
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: