1083130389 NPI number — MR. GINO C LAZARO DIRECTOR OF NURSING

Table of content: MR. GINO C LAZARO DIRECTOR OF NURSING (NPI 1083130389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083130389 NPI number — MR. GINO C LAZARO DIRECTOR OF NURSING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZARO
Provider First Name:
GINO
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DIRECTOR OF NURSING
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083130389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23331 MALTBY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARBOR CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-486-5106
Provider Business Mailing Address Fax Number:
424-263-4750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23331 MALTBY PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-486-5106
Provider Business Practice Location Address Fax Number:
424-263-4750
Provider Enumeration Date:
08/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  552043 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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