Provider Demographics
NPI:1235729278
Name:LAZARO, CLAIRE BAUTISTA
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:BAUTISTA
Last Name:LAZARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 MAVERICK CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7991
Mailing Address - Country:US
Mailing Address - Phone:209-818-8394
Mailing Address - Fax:
Practice Address - Street 1:3440 MCHENRY AVE STE D6
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1469
Practice Address - Country:US
Practice Address - Phone:209-529-1542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily