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General NPI Number Information
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NPI Number | 1912458845
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Entity Type | Individual
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Provider Name | BRYAN KEOKE LAZARO PMHNP
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Gender | Male
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 2111 E BASELINE RD STE F4
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City | TEMPE
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State | AZ
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Zip | 85283-1519
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Country | US
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Telephone | 602-888-3474
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Fax | 762-212-4347
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Provider Business Mailing Address
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Address Line | 5223 1/2 S 5TH ST
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City | PHOENIX
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State | AZ
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Zip | 85040-8707
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Country | US
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Telephone | 602-888-3474
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP9561
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License Number State | AZ
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