Provider Demographics
NPI:1124212303
Name:LAZATIN, SERGIO C JR (DC)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:C
Last Name:LAZATIN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:SERGE
Other - Middle Name:C
Other - Last Name:LAZATIN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:10066 SILVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2453
Mailing Address - Country:US
Mailing Address - Phone:818-395-7925
Mailing Address - Fax:
Practice Address - Street 1:11633 SAN VICENTE BLVD STE 214
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6513
Practice Address - Country:US
Practice Address - Phone:818-395-7925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor