Provider Demographics
NPI:1942629779
Name:SUMARRIVA LEZAMA, LHARA MARIA DE LOS ANGELES (MD)
Entity Type:Individual
Prefix:
First Name:LHARA
Middle Name:MARIA DE LOS ANGELES
Last Name:SUMARRIVA LEZAMA
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 1:1425 BROADWAY
Mailing Address - Street 2:APT. 2R
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:646-531-6661
Mailing Address - Fax:
Practice Address - Street 1:1425 BROADWAY
Practice Address - Street 2:APT. 2R
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:646-531-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program