Provider Demographics
NPI:1699812693
Name:LAZO, MANUEL CABERTO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:CABERTO
Last Name:LAZO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 W SUNSET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1594
Mailing Address - Country:US
Mailing Address - Phone:323-660-5630
Mailing Address - Fax:323-953-4980
Practice Address - Street 1:3827 W SUNSET BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1594
Practice Address - Country:US
Practice Address - Phone:323-660-5630
Practice Address - Fax:323-953-4980
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice