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General NPI Number Information
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NPI Number | 1194532457
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Entity Type | Individual
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Provider Name | SOPHIA LAZZARONI
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 120 E OGDEN AVE STE 101
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City | HINSDALE
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State | IL
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Zip | 60521-3892
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Country | US
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Telephone | 708-434-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 425 EDGEWOOD PL APT 2
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City | RIVER FOREST
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State | IL
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Zip | 60305-1667
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Country | US
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Telephone | 262-581-6215
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.010980
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License Number State | IL
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