Provider Demographics
NPI:1851314413
Name:LAZARUS, LEONARD HILLEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:HILLEL
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEONARD
Other - Middle Name:HILLEL
Other - Last Name:LAZARUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7450 OLIVETAS AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4924
Mailing Address - Country:US
Mailing Address - Phone:858-450-5286
Mailing Address - Fax:858-454-4579
Practice Address - Street 1:7450 OLIVETAS AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4900
Practice Address - Country:US
Practice Address - Phone:858-450-5286
Practice Address - Fax:858-454-4579
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFF633YMedicare PIN
CAA40022Medicare ID - Type Unspecified
CAA29024Medicare UPIN
CAFF633ZMedicare PIN