MEDICARE: DR. JOEL DEAN LAZAR PHD

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
1	103T00000X	Psychologist	PSY12520	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124123708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL DEAN LAZAR PHD

Provider Business Mailing Address
First Line	:	1267 ROSECRANS ST
Second Line	:	SUITE E
City	:	SAN DIEGO
State	:	CA
Zip	:	92106
Country	:	US
Telephone Number	:	619-540-6038
Fax Number	:	619-426-1906

Provider Business Practice Location Address
First Line	:	1267 ROSECRANS ST
Second Line	:	SUITE E
City	:	SAN DIEGO
State	:	CA
Zip	:	92106
Country	:	US
Telephone Number	:	619-540-6038
Fax Number	:	619-426-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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