Provider Demographics
NPI:1982416541
Name:LAZARO, ELDA
Entity type:Individual
Prefix:
First Name:ELDA
Middle Name:
Last Name:LAZARO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 YALE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4772
Mailing Address - Country:US
Mailing Address - Phone:310-405-4444
Mailing Address - Fax:
Practice Address - Street 1:1150 YALE ST.
Practice Address - Street 2:UNIT 1
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4717
Practice Address - Country:US
Practice Address - Phone:310-405-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA668291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical