Provider Demographics
NPI:1598210411
Name:ST. LAZARUS FAMILY PRACTICE P.A.
Entity Type:Organization
Organization Name:ST. LAZARUS FAMILY PRACTICE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-802-7003
Mailing Address - Street 1:14345 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7723
Mailing Address - Country:US
Mailing Address - Phone:210-802-7003
Mailing Address - Fax:210-519-2970
Practice Address - Street 1:14345 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7723
Practice Address - Country:US
Practice Address - Phone:210-802-7003
Practice Address - Fax:210-519-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8176208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty