Provider Demographics
NPI:1902868789
Name:PARAS, RODERICK ROPHEO LAZO
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:ROPHEO LAZO
Last Name:PARAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44151 15TH ST W STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4079
Practice Address - Country:US
Practice Address - Phone:661-902-5600
Practice Address - Fax:661-951-0686
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89506207RX0202X
FLME 90374207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17410400Medicaid
AL141279Medicaid
FL17410400Medicaid
AL140929Medicaid
H54081Medicare UPIN