Organization
LAKESIDE YOUTH N KIDS PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE JESSE LAZATIN M.D. (PHYSICIAN/OWNER)
(916) 300-7534
Entity
Organization
Contact information
Practice address
6055 W 46TH AVE, WHEAT RIDGE, CO 80033-1811
(916) 300-7534
Mailing address
6055 W 46TH AVE, WHEAT RIDGE, CO 80033-1811
(916) 300-7534
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
50291
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
63008564
—
CO
Enumeration date
09/25/2015
Last updated
09/25/2015
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