Provider Demographics
NPI:1780887083
Name:LAZARENO, BERNY ESTEEV
Entity type:Individual
Prefix:MR
First Name:BERNY
Middle Name:ESTEEV
Last Name:LAZARENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3881 S. WESTERN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062
Mailing Address - Country:US
Mailing Address - Phone:323-290-4375
Mailing Address - Fax:323-293-8159
Practice Address - Street 1:936 CAROB WAY APT 2
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-5828
Practice Address - Country:US
Practice Address - Phone:323-253-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor