Healthcare Provider Details

I. General information

NPI: 1245413905
Provider Name (Legal Business Name): LAZARO FRAGA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 S LE JEUNE RD STE 302
CORAL GABLES FL
33134-2616
US

IV. Provider business mailing address

5590 W 20TH AVE STE 300
HIALEAH FL
33016-7061
US

V. Phone/Fax

Practice location:
  • Phone: 305-443-5031
  • Fax:
Mailing address:
  • Phone: 305-442-1740
  • Fax: 305-442-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberACN961
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number279233800
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RENE CASANOVA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-363-3675