Provider Demographics
NPI:1508299827
Name:SAINT LAZARO MEDICAL CENTER INC
Entity Type:Organization
Organization Name:SAINT LAZARO MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-256-6586
Mailing Address - Street 1:11117 S INGLEWOOD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LENNOX
Mailing Address - State:CA
Mailing Address - Zip Code:90304-2514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11117 S INGLEWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LENNOX
Practice Address - State:CA
Practice Address - Zip Code:90304-2514
Practice Address - Country:US
Practice Address - Phone:310-673-0658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty