Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 0101032961 | VA |
NPI | 1013963362 |
---|---|
Provider Name | Dr. Raul A Lazarte |
First Address | Fairfax, VA 22031-2238 |
Second Address | Falls Church, VA 22042-3307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198-8922 | ECFMG (01) | |
6717799 | (05) | VA |
6717802 | (05) | VA |
6747167 | (05) | VA |
D78017 | (02) |