Provider Demographics
NPI:1346868403
Name:LANZA, RICARDO IGNACIO JR (RN)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:IGNACIO
Last Name:LANZA
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-0426
Mailing Address - Country:US
Mailing Address - Phone:310-650-4757
Mailing Address - Fax:
Practice Address - Street 1:11947 YORK AVE APT C
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3266
Practice Address - Country:US
Practice Address - Phone:310-650-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95184571364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health