Provider Demographics
NPI:1609656750
Name:LAZCANO VILLAGRAN, CHRISTOPHER LAZCANO
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LAZCANO
Last Name:LAZCANO VILLAGRAN
Suffix:
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 1:20 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-2010
Mailing Address - Country:US
Mailing Address - Phone:781-479-7925
Mailing Address - Fax:
Practice Address - Street 1:20 LINDEN ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2010
Practice Address - Country:US
Practice Address - Phone:781-479-7925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker