Provider Demographics
NPI:1780029413
Name:BEN ARI LAZCANO, JUDITH SABRINA (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:SABRINA
Last Name:BEN ARI LAZCANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371540
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-1540
Mailing Address - Country:US
Mailing Address - Phone:702-383-2420
Mailing Address - Fax:702-383-8402
Practice Address - Street 1:1800 W. CHARLESTON BLVD
Practice Address - Street 2:PEDIATRIC CRITICAL CARE ADMINISTRATION
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-383-2420
Practice Address - Fax:702-383-8402
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV166762080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY995534444OtherDRIVER LICENSE