Provider Demographics
NPI:1568840346
Name:LAZALDE, RICHARD JOSHUWA (ATC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSHUWA
Last Name:LAZALDE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22723 BAY AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8637
Mailing Address - Country:US
Mailing Address - Phone:951-536-5894
Mailing Address - Fax:
Practice Address - Street 1:22723 BAY AVE APT 118
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8637
Practice Address - Country:US
Practice Address - Phone:951-536-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer