Provider Demographics
NPI:1033464110
Name:LAZZARO, CYNTHIA CHEN (DO)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:CHEN
Last Name:LAZZARO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 WESTCLIFF DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5524
Mailing Address - Country:US
Mailing Address - Phone:949-515-4111
Mailing Address - Fax:
Practice Address - Street 1:1617 WESTCLIFF DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5524
Practice Address - Country:US
Practice Address - Phone:949-515-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12781207N00000X
MI5101020094207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology