Provider Demographics
NPI:1952628422
Name:LAZARIN, MARGAUX (DO)
Entity Type:Individual
Prefix:
First Name:MARGAUX
Middle Name:
Last Name:LAZARIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:
Practice Address - Street 1:2907 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-4003
Practice Address - Country:US
Practice Address - Phone:650-503-7810
Practice Address - Fax:650-298-9875
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270506207Q00000X
CA14488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03732496Medicaid
NY03732496Medicaid