Provider Demographics
NPI:1376742072
Name:LAZAR, SHARONA C (RD)
Entity Type:Individual
Prefix:MRS
First Name:SHARONA
Middle Name:C
Last Name:LAZAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12648 MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1514
Mailing Address - Country:US
Mailing Address - Phone:818-755-9399
Mailing Address - Fax:
Practice Address - Street 1:12648 MARTHA ST
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1514
Practice Address - Country:US
Practice Address - Phone:818-755-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA881194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered