Provider Demographics
NPI:1710490578
Name:LAZAR, RAMONA (PT)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 EL CAMINO AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4938
Mailing Address - Country:US
Mailing Address - Phone:916-487-3473
Mailing Address - Fax:916-487-3483
Practice Address - Street 1:4737 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4938
Practice Address - Country:US
Practice Address - Phone:916-487-3473
Practice Address - Fax:916-487-3483
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294012208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation