Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A64276 | CA |
N | 208200000X | Surgeon | F63421 | CA |
N | 208600000X | Surgeon | F63421 | CA |
NPI | 1073538112 |
---|---|
Provider Name | Jorge Antonio Lazareff |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 23/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A642760 | (05) | CA |
F63421 | (02) | CA |