=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265386585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAZARUS HEALING CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2026
-----------------------------------------------------
Last Update Date | 02/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4992 EAST PARK RD
-----------------------------------------------------
City | STONYFORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-900-1029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2999 DOUGLAS BLVD STE 180
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-900-1029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. JENNY L LAZARUS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 916-900-1029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------