Provider Demographics
NPI:1700642311
Name:LAZARO, CARL VIRGIL BELAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARL VIRGIL
Middle Name:BELAN
Last Name:LAZARO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3941A BRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3707
Mailing Address - Country:US
Mailing Address - Phone:562-676-8028
Mailing Address - Fax:
Practice Address - Street 1:1250 N BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90840-0004
Practice Address - Country:US
Practice Address - Phone:562-676-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant