| Lakeside Youth N Kids Pediatrics | |
|
6055 W 46th Ave Wheat Ridge CO 80033-1811 | |
| (916) 300-7534 | |
| Not Available |
| Full Name | Lakeside Youth N Kids Pediatrics |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 6055 W 46th Ave, Wheat Ridge, Colorado |
| Authorized Official Name and Position | Lance Jesse Lazatin (PHYSICIAN/OWNER) |
| Authorized Official Contact | 9163007534 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Youth N Kids Pediatrics 6055 W 46th Ave Wheat Ridge CO 80033-1811 Ph: (916) 300-7534 | Lakeside Youth N Kids Pediatrics 6055 W 46th Ave Wheat Ridge CO 80033-1811 Ph: (916) 300-7534 |
| NPI Number | 1275903833 |
|---|---|
| Provider Enumeration Date | 09/25/2015 |
| Last Update Date | 09/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275903833 | NPI | - | NPPES |
| 63008564 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 50291 (Colorado) | Primary |
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