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General NPI Number Information
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NPI Number | 1912470006
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Entity Type | Individual
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Provider Name | SELENA MARIA LAZZAROTTO
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 1910 OLYMPIC BLVD
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5096
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Country | US
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Telephone | 925-433-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 COURAGE DR
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City | FAIRFIELD
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State | CA
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Zip | 94533-6717
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Country | US
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Telephone | 707-784-2080
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Fax | 707-425-4014
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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