Provider Demographics
NPI:1215272042
Name:HAZARD, LISA LORRAINE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LORRAINE
Last Name:HAZARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 N CITRUS AVE
Mailing Address - Street 2:APT. 50
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2787
Mailing Address - Country:US
Mailing Address - Phone:877-396-9447
Mailing Address - Fax:877-476-6158
Practice Address - Street 1:309 S MAPLE ST STE 5
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4122
Practice Address - Country:US
Practice Address - Phone:760-745-1713
Practice Address - Fax:760-745-1375
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT52191246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00052191OtherCPT