Basic Information
| Provider Information | |||||||||
| NPI: | 1457533226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACAZOTTE | ||||||||
| FirstName: | PIERRE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | A.U. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12927 SLEEPY WIND ST | ||||||||
| Address2: | |||||||||
| City: | MOORPARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930212935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109893092 | ||||||||
| FaxNumber: | 8055303989 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 3RD AVE | ||||||||
| Address2: | STE. C-11 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919103953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194260841 | ||||||||
| FaxNumber: | 6194269197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 06/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AU1381 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | AU0013810 | 05 | CA | MEDICAID |