Provider Demographics
NPI:1699985663
Name:LAZZARO, WILLIAM ARTHUR
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:LAZZARO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5729
Mailing Address - Country:US
Mailing Address - Phone:619-773-7480
Mailing Address - Fax:
Practice Address - Street 1:2049 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-4221
Practice Address - Country:US
Practice Address - Phone:619-465-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)