Provider Demographics
NPI:1336131317
Name:LAZO, ELEANOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:
Last Name:LAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ANSEL RD
Mailing Address - Street 2:#5
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4069
Mailing Address - Country:US
Mailing Address - Phone:650-343-9746
Mailing Address - Fax:650-343-9746
Practice Address - Street 1:901 CAMPUS DR
Practice Address - Street 2:#101
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4900
Practice Address - Country:US
Practice Address - Phone:650-991-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50026207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF32280Medicare UPIN
CA00A500261Medicare ID - Type UnspecifiedPROVIDER NUMBER