Individual
ELADIO MARIANO LACSAMANA TIZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1040 W IMPERIAL HWY STE D, LA HABRA, CA 90631-0608
(714) 451-1072
(714) 451-1078
Mailing address
19016 SHAKESPEARE DR, WALNUT, CA 91789-4239
(626) 641-2072
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
23647
CA
Other
Enumeration date
03/06/2014
Last updated
04/24/2019
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