Active NPI
Laura Hanzlik, P.A.-C.
- Surgical Physician Assistant
- San Diego, CA
National Provider Identifier
1497727655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 12647
- Practice address
- 2650 Stockton Rd
BLDG 624
San Diego, CA 92106-6000 - Phone
- (619) 524-0146
- NPI assigned
- Feb 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 12647 | CA | Primary |
Addresses
Primary practice location
2650 Stockton Rd
BLDG 624
San Diego, CA 92106-6000
Mailing address
11749 Aspen View Dr
San Diego, CA 92128-5285
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12647 | CA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497727655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11749 ASPEN VIEW DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921285285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 STOCKTON RD",
"address_2": "BLDG 624",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921066000",
"telephone_number": "619-524-0146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANZLIK",
"first_name": "LAURA",
"name_prefix": "Mrs.",
"credential": "P.A.-C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CA",
"license": "12647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.