Provider Demographics
NPI:1427073576
Name:ALONSO, LAZARO VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:VICTOR
Last Name:ALONSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15216 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3601
Mailing Address - Country:US
Mailing Address - Phone:818-785-7875
Mailing Address - Fax:818-909-7924
Practice Address - Street 1:15216 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3601
Practice Address - Country:US
Practice Address - Phone:818-785-7875
Practice Address - Fax:818-909-7924
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A393430Medicaid
CA00A393430Medicaid