Provider Demographics
NPI:1154301307
Name:LAZO, EDWARD H (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:LAZO
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:227 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3711
Mailing Address - Country:US
Mailing Address - Phone:650-483-0387
Mailing Address - Fax:650-593-8711
Practice Address - Street 1:1155 N VERMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1728
Practice Address - Country:US
Practice Address - Phone:650-483-0387
Practice Address - Fax:650-593-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2013-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE1170213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0211610001Medicare NSC
CAE1170Medicare PIN
CAT19076Medicare UPIN