Provider Demographics
NPI:1760850713
Name:LAZENBY, RITA YOLANDA (RN, MSN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:YOLANDA
Last Name:LAZENBY
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10417 BEDFORD CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4611
Mailing Address - Country:US
Mailing Address - Phone:323-683-4727
Mailing Address - Fax:
Practice Address - Street 1:10417 BEDFORD CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4611
Practice Address - Country:US
Practice Address - Phone:323-683-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse