Provider Demographics
NPI:1891881215
Name:LAZAREK, TIMOTHY FRANCIS (NP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FRANCIS
Last Name:LAZAREK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 CAMINO DEL RIO S STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4014
Mailing Address - Country:US
Mailing Address - Phone:619-287-9730
Mailing Address - Fax:619-398-1869
Practice Address - Street 1:3633 CAMINO DEL RIO S STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4014
Practice Address - Country:US
Practice Address - Phone:619-287-9730
Practice Address - Fax:619-398-1869
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP11320AMedicare PIN
CADB256ZMedicare PIN