Provider Demographics
NPI:1518744630
Name:LAZO, MIGUEL ALBERTO JR
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ALBERTO
Last Name:LAZO
Suffix:JR
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 1:1400 S GRAND AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3068
Mailing Address - Country:US
Mailing Address - Phone:213-742-6250
Mailing Address - Fax:
Practice Address - Street 1:1400 S GRAND AVE STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3068
Practice Address - Country:US
Practice Address - Phone:213-742-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker