Provider Demographics
NPI:1679256739
Name:LAZO, NESTOR (LMT)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:LAZO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7277 W CAMERO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4643
Mailing Address - Country:US
Mailing Address - Phone:808-464-8019
Mailing Address - Fax:
Practice Address - Street 1:7277 W CAMERO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4643
Practice Address - Country:US
Practice Address - Phone:808-464-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLVMT.12134225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist