MEDICARE: DR. SERGIO C LAZATIN JR. D.C.

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	111N00000X	Chiropractor	DC-30358	CA

General Provider Information

NPI Number	:	1124212303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO C LAZATIN JR. D.C.

Provider Business Mailing Address
First Line	:	10066 SILVERTON AVE
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91042-2453
Country	:	US
Telephone Number	:	818-395-7925
Fax Number	:

Provider Business Practice Location Address
First Line	:	11633 SAN VICENTE BLVD STE 214
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6513
Country	:	US
Telephone Number	:	818-395-7925
Fax Number	:

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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