Lazaro Gurovich Wisnia, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A32074 Issued in CA

Practice address

880 S Atlantic Blvd
#302
Monterey Park, CA 91754-4700

Phone

(626) 576-8040

Fax

(626) 576-8079

NPI assigned

Nov 29, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Lazaro Wisnia, M.D., Inc

  • Urology Physician
  • Monterey Park, CA
  • NPI 1285729152
  NPD (past) Authorized official

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1528041001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 S ATLANTIC BLVD",
            "address_2": "#302",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917544700",
            "telephone_number": "626-576-8040",
            "fax_number": "626-576-8079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 S ATLANTIC BLVD",
            "address_2": "#302",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917544700",
            "telephone_number": "626-576-8040",
            "fax_number": "626-576-8079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNIA",
        "first_name": "LAZARO",
        "middle_name": "GUROVICH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A32074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A320741",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Demetri Williams, M.D.
• Timothy David Williams
• Wilshire District Medical Group
• Winnie K Pang MD Inc
• Winston C San Agustin, M.D Inc
• Aimee Wong
• Alan Lew Wong, LCSW
• Andrea Wong, D. C.
• Bertram Dennis Wong, D.C.
• Chris Wong, PHARM.D.

• Specialist in Monterey Park, CA
• Providers in Monterey Park, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.