Provider Demographics
NPI:1851662464
Name:STEPHEN EARL LAZARUS, M.D., INC.
Entity type:Organization
Organization Name:STEPHEN EARL LAZARUS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-361-4726
Mailing Address - Street 1:PO BOX 9126
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91309-0126
Mailing Address - Country:US
Mailing Address - Phone:818-709-8161
Mailing Address - Fax:818-709-8160
Practice Address - Street 1:1041 E. YORBA LINDA BL. #203
Practice Address - Street 2:C/O PLACENTIA-LINDA WOUND CARE
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3728
Practice Address - Country:US
Practice Address - Phone:714-524-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23575207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G235750Medicaid
CAG23575Medicare PIN