Basic Information
| Provider Information | |||||||||
| NPI: | 1659694073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANZARIN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JONATHAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | CATC #122789 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ALLERTON ST | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505999955 | ||||||||
| FaxNumber: | 6505999273 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ALLERTON ST | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505999955 | ||||||||
| FaxNumber: | 6505999273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2010 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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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 | 101YA0400X | 122789 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 122789 | 01 | CA | CALIFORNIA ASSOCIATION FOR ALCOHOL/DRUG EDUCATORS | OTHER |