Provider Demographics
NPI:1932598612
Name:ELVIR LAZO, OFELIA LOANI
Entity type:Individual
Prefix:
First Name:OFELIA
Middle Name:LOANI
Last Name:ELVIR LAZO
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 1:467 ARNAZ DR APT 317
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6708
Mailing Address - Country:US
Mailing Address - Phone:310-721-4220
Mailing Address - Fax:
Practice Address - Street 1:467 ARNAZ DR APT 317
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6708
Practice Address - Country:US
Practice Address - Phone:310-721-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14-456246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14-456OtherTHE AMERICAN BOARD OF SURGICAL ASSISTANS