Basic Information
| Provider Information | |||||||||
| NPI: | 1740613041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAZARUS | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 E DIVISADERO ST | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937211431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594432682 | ||||||||
| FaxNumber: | 5594432681 | ||||||||
| Practice Location | |||||||||
| Address1: | 729 N MEDICAL CENTER DR W | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593200531 | ||||||||
| FaxNumber: | 5593200539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2013 | ||||||||
| LastUpdateDate: | 06/30/2014 | ||||||||
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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 | 363AS0400X | PA23072 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | PA23072 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.