Provider Demographics
NPI:1518045822
Name:LACBAWAN, FELICITAS LARDIZABAL (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICITAS
Middle Name:LARDIZABAL
Last Name:LACBAWAN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:CLEVELAND CLINIC MOLECULAR PATHOLOGY MC:LL2-2
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-0761
Mailing Address - Fax:216-445-0681
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:CLEVELAND CLINIC MOLECULAR PATHOLOGY MC:LL2-2
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-0761
Practice Address - Fax:216-445-0681
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35098505207ZP0007X
NY253903-1207ZP0007X, 207ZP0102X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02347Medicare UPIN