Provider Demographics
NPI:1427550151
Name:LAZARO, NINFA MAE REYES
Entity Type:Individual
Prefix:MS
First Name:NINFA MAE
Middle Name:REYES
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 1:1735 ROWAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5631
Mailing Address - Country:US
Mailing Address - Phone:619-888-1189
Mailing Address - Fax:
Practice Address - Street 1:4075 54TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2301
Practice Address - Country:US
Practice Address - Phone:619-582-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95130694163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY4537725OtherDRIVER'S LICENSE