Provider Demographics
NPI:1295013431
Name:LEONARD H LAZARUS MD INC
Entity Type:Organization
Organization Name:LEONARD H LAZARUS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:HILLEL
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:858-454-2317
Mailing Address - Street 1:7450 OLIVETAS AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4902
Mailing Address - Country:US
Mailing Address - Phone:858-454-7157
Mailing Address - Fax:858-450-5284
Practice Address - Street 1:7450 OLIVETAS AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4902
Practice Address - Country:US
Practice Address - Phone:858-454-7157
Practice Address - Fax:858-450-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29024Medicare UPIN
CAFF633BMedicare PIN
CAA40022Medicare PIN
CAFF633AMedicare PIN