Provider Demographics
NPI:1942424288
Name:LAZATIN, LOURDES (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:
Last Name:LAZATIN
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 1:451 W GONZALES RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-9004
Mailing Address - Country:US
Mailing Address - Phone:805-983-3557
Mailing Address - Fax:805-983-2337
Practice Address - Street 1:451 W GONZALES RD
Practice Address - Street 2:SUITE 260
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-9004
Practice Address - Country:US
Practice Address - Phone:805-983-3557
Practice Address - Fax:805-983-2337
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32947171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32947OtherSTATE LICENSE