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NPI Code Detail

MEDICARE: JEROME LAZAGA M.D.

MEDICARE: JEROME LAZAGA M.D.
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 PhysicianA136929CA

General Provider Information

NPI Number : 1639417181
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEROME LAZAGA M.D.
Provider Business Mailing Address
First Line : 1800 HARRISON ST, 7TH FL
Second Line :
City : OAKLAND
State : CA
Zip : 94612-3429
Country : US
Telephone Number : 510-625-4101
Fax Number :
Provider Business Practice Location Address
First Line : 3700 MALL VIEW RD
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93306-3050
Country : US
Telephone Number : 661-334-2801
Fax Number : 661-334-2906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2013
Last Update Date : 01/21/2022

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