Provider Demographics
NPI:1225595457
Name:SYPH, LAKI LAMAR
Entity Type:Individual
Prefix:
First Name:LAKI
Middle Name:LAMAR
Last Name:SYPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11002 W MONTE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5465
Mailing Address - Country:US
Mailing Address - Phone:480-252-4796
Mailing Address - Fax:
Practice Address - Street 1:5251 W CAMPBELL AVE STE 209
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1719
Practice Address - Country:US
Practice Address - Phone:623-295-9761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty