Provider Demographics
NPI:1679074280
Name:LAZO, GEORGE ALEXANDER FUTCH JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE ALEXANDER
Middle Name:FUTCH
Last Name:LAZO
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 CLARK WAY
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 CLARK WAY
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2300
Practice Address - Country:US
Practice Address - Phone:650-617-3823
Practice Address - Fax:650-688-3669
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical