Provider Demographics
NPI:1508235599
Name:LAZAGA, ARNOLD
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:
Last Name:LAZAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12466 SHALLMAN ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3600
Mailing Address - Country:US
Mailing Address - Phone:858-248-6656
Mailing Address - Fax:
Practice Address - Street 1:12466 SHALLMAN ST
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-3600
Practice Address - Country:US
Practice Address - Phone:858-513-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42825OtherPHYSICAL THERAPY BOARD OF CALIFORNIA