Active NPI
George Alexander Futch Lazo Jr., PSYD
- Clinical Psychologist
- Palo Alto, CA
National Provider Identifier
1679074280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 29901
- Practice address
- 650 Clark Way
Palo Alto, CA 94304-2300 - Phone
- (650) 617-3823
- Fax
- (650) 688-3669
- NPI assigned
- Feb 28, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 29901 | CA | Primary |
Addresses
Primary practice location
650 Clark Way
Palo Alto, CA 94304-2300
Mailing address
650 Clark Way
Palo Alto, CA 94304-2300
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: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29901 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610150400000",
"number": "1679074280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 CLARK WAY",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943042300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 CLARK WAY",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943042300",
"telephone_number": "650-617-3823",
"fax_number": "650-688-3669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAZO",
"first_name": "GEORGE ALEXANDER",
"middle_name": "FUTCH",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-28",
"last_updated": "2021-01-09",
"certification_date": "2021-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "29901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2021; 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.