Provider Demographics
NPI:1295098390
Name:LEZCANO, SHEILA (MD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:LEZCANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2469
Mailing Address - Country:US
Mailing Address - Phone:323-307-8900
Mailing Address - Fax:323-881-8864
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2469
Practice Address - Country:US
Practice Address - Phone:323-307-8900
Practice Address - Fax:323-881-8864
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA130548207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program