Individual provider Active NPI

Cynthia Chen Lazzaro, D.O.

  • Dermatology Physician
  • Newport Beach, CA
National Provider Identifier
1033464110
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
20A12781 Issued in CA
Practice address
1617 Westcliff Dr
Suite 100
Newport Beach, CA 92660-5524
Phone
(949) 515-4111
NPI assigned
Jul 16, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 20A12781 CA Primary
Dermatology Physician 207N00000X 5101020094 MI

Addresses

Primary practice location

1617 Westcliff Dr
Suite 100
Newport Beach, CA 92660-5524

Mailing address

1617 Westcliff Dr
Suite 100
Newport Beach, CA 92660-5524
Phone (949) 515-4111

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160205000417 CA Practitioner - Dermatology 1355584590 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

18600 S Figueroa St
Gardena, CA 90248-4505
Phone (310) 325-5111

25821 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

25825 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A12781CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Sep 27, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 27, 2021 Accepting new patients
Howard Fein MD Inc Dermatology CurrentSince Dec 8, 2016 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Healthcare Partners Affiliates Medical Group Dermatology CurrentSince Jan 11, 2016 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Jan 11, 2016 Accepting new patients
Good Derm, Inc Dermatology CurrentSince Jul 12, 2020 Accepting new patients
Palos Verdes Skin Surgery Ctr Inc Past Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

441 N Lakeview Ave
Anaheim, CA 92807
Phone (714) 279-4000

1236 N Magnolia Ave
Anaheim, CA 92801
Phone (714) 995-1000

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

10441 Lakewood Blvd
Ste A
Downey, CA 90241

10441 Lakewood Blvd
Ste Ab
Downey, CA 90241
Phone (562) 869-1070

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

5865 E Naples Plz
Long Beach, CA 90803
Phone (310) 541-7800

2601 Via Campo
Montebello, CA 90640
Phone (323) 720-1144

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

550 Deep Valley Dr
Ste 283
Rolling Hills Estates, CA 90274
Phone (310) 541-7800

550 Deep Valley Dr
Ste 287
Rolling Hills Estates, CA 90274
Phone (310) 541-7800

13928 Seal Beach Blvd
Seal Beach, CA 90740
Phone (561) 459-7100

3640 Lomita Blvd
Ste 301
Torrance, CA 90505
Phone (310) 405-0693

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBBCCD

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1033464110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 WESTCLIFF DR",
            "address_2": "SUITE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926605524",
            "telephone_number": "949-515-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 WESTCLIFF DR",
            "address_2": "SUITE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926605524",
            "telephone_number": "949-515-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAZZARO",
        "first_name": "CYNTHIA",
        "middle_name": "CHEN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-16",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "20A12781",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5101020094",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.