Individual
JOHN LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24451 HEALTH CENTER DR, LAGUNA HILLS, CA 92653-3689
(949) 452-3050
(949) 452-3066
Mailing address
PO BOX 6388, SAN PEDRO, CA 90734-6388
(310) 225-3244
(310) 698-7054
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G79003
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G790030
—
CA
Enumeration date
06/13/2006
Last updated
12/14/2021
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