Provider Demographics
NPI:1801008321
Name:LACAZE, RAULINE MARTHA
Entity Type:Individual
Prefix:MRS
First Name:RAULINE
Middle Name:MARTHA
Last Name:LACAZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MAIN STREET
Mailing Address - Street 2:# 835
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245
Mailing Address - Country:US
Mailing Address - Phone:310-640-2574
Mailing Address - Fax:310-640-2572
Practice Address - Street 1:531 MAIN STREET
Practice Address - Street 2:835
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:310-640-2574
Practice Address - Fax:310-640-2572
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1873237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA1873OtherHEARING AID DISPENSER