Healthcare Provider Details

I. General information

NPI: 1063247518
Provider Name (Legal Business Name): ALIYAH ROSITA LAZCANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BROADWAY ST SUITE 301
TACOMA WA
98402-1848
US

IV. Provider business mailing address

920 BROADWAY ST SUITE 301
TACOMA WA
98402-1848
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-4354
  • Fax: 855-373-4004
Mailing address:
  • Phone: 253-292-4354
  • Fax: 855-373-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: