Provider Demographics
NPI:1598115677
Name:LAZZAROTTO, MANA BEHJAT SASSANPOUR (DO)
Entity Type:Individual
Prefix:DR
First Name:MANA
Middle Name:BEHJAT SASSANPOUR
Last Name:LAZZAROTTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2772 JOHNSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7261
Mailing Address - Country:US
Mailing Address - Phone:805-642-1430
Mailing Address - Fax:
Practice Address - Street 1:3555 LOMA VISTA RD STE 110
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-653-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine