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NPI Code Detail

MEDICARE: ERIC U LAZO LLC

MEDICARE: ERIC U LAZO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1053592774
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERIC U LAZO LLC
Provider Business Mailing Address
First Line : PO BOX 26302
Second Line :
City : LAS VEGAS
State : NV
Zip : 89126-0302
Country : US
Telephone Number : 702-968-0102
Fax Number : 702-968-0104
Provider Business Practice Location Address
First Line : 3301 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1835
Country : US
Telephone Number : 702-968-0102
Fax Number : 702-968-0104
Authorized Official
Title or Position : PHYSICIAN OWNER
Name : ERIC ULANDAY LAZO
Credential : MD
Telephone Number : 702-968-0102
Provider Enumeration Date : 11/21/2007
Last Update Date : 11/21/2007

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Directions to “ERIC U LAZO LLC ” Practice Location

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