MEDICARE: ANDREA LAZAR L.AC.

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	171100000X	Acupuncturist	14111	CA

General Provider Information

NPI Number	:	1447525951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LAZAR L.AC.

Provider Business Mailing Address
First Line	:	1734 DON CARLOS AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-2218
Country	:	US
Telephone Number	:	916-390-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 W BROADWAY
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1120
Country	:	US
Telephone Number	:	916-390-2265
Fax Number	:

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

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	03/16/2012

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