Basic Information
| Provider Information | |||||||||
| NPI: | 1700403482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAZARO | ||||||||
| FirstName: | CHRISTINE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 SCOTTS VLY | ||||||||
| Address2: | |||||||||
| City: | HERCULES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945473960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108130920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943012219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668396979 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2020 | ||||||||
| LastUpdateDate: | 06/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 297883 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.