Provider Demographics
NPI:1205850641
Name:DER SARKISSIAN, LAZIK (MD)
Entity Type:Individual
Prefix:
First Name:LAZIK
Middle Name:
Last Name:DER SARKISSIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N CENTRAL AVE
Mailing Address - Street 2:205
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1916
Mailing Address - Country:US
Mailing Address - Phone:818-243-9463
Mailing Address - Fax:818-243-5416
Practice Address - Street 1:540 N CENTRAL AVE
Practice Address - Street 2:205
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1916
Practice Address - Country:US
Practice Address - Phone:818-243-9463
Practice Address - Fax:818-243-5416
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA041167207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A411672Medicaid
CA00A411672Medicaid
CAA41167AMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION