Provider Demographics
NPI:1891894713
Name:LANZAT, MISHA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MISHA
Middle Name:
Last Name:LANZAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3743 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1703
Mailing Address - Country:US
Mailing Address - Phone:323-268-2711
Mailing Address - Fax:323-268-9260
Practice Address - Street 1:3743 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1703
Practice Address - Country:US
Practice Address - Phone:323-268-2711
Practice Address - Fax:323-268-9260
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3726213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37260Medicaid
CAU09631Medicare UPIN
CAWE3726AMedicare PIN
CA000E37260Medicaid