# MARC A. LAZZARA D.O., A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285733949
- **Authorized official:** DR. MARC ADAM LAZZARA D.O. (CEO)
- **Authorized official phone:** (714) 544-8167

## Contact information

- **Practice address:** 4521 CHARLEVILLE CIR, IRVINE, CA 92604-2329
- **Practice address phone:** (714) 544-8167
- **Practice address fax:** (949) 679-1909
- **Mailing address:** 4521 CHARLEVILLE CIR, IRVINE, CA 92604-2329
- **Mailing address phone:** (714) 544-8167
- **Mailing address fax:** (949) 679-1909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 20A7964 | CA | Yes |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 12/05/2008