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General NPI Number Information
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NPI Number | 1285729152
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Entity Type | Organization
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Legal Business Name | LAZARO WISNIA, M.D., INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 880 S ATLANTIC BLVD SUITE 302
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City | MONTEREY PARK
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State | CA
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Zip | 91754-4700
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Country | US
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Telephone | 626-576-8040
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Fax | 626-576-4186
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Provider Business Mailing Address
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Address Line | 880 S ATLANTIC BLVD SUITE 302
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City | MONTEREY PARK
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State | CA
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Zip | 91754-4700
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Country | US
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Telephone | 626-576-8040
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Fax | 626-576-4186
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Authorized Official
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Title or Position | MEDICAL DOCTOR/DIRECTOR
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Name | LAZARO G. WISNIA
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Credential | M.D
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Telephone | 626-576-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A32074
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License Number State | CA
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