Provider Demographics
NPI:1548670912
Name:LAZAROVA, GERGINA VALERIEVA
Entity type:Individual
Prefix:
First Name:GERGINA
Middle Name:VALERIEVA
Last Name:LAZAROVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 BRIER RD
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8446
Mailing Address - Country:US
Mailing Address - Phone:425-773-1141
Mailing Address - Fax:
Practice Address - Street 1:24100 BRIER RD
Practice Address - Street 2:
Practice Address - City:BRIER
Practice Address - State:WA
Practice Address - Zip Code:98036-8446
Practice Address - Country:US
Practice Address - Phone:425-773-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60403986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist