Healthcare Provider Details

I. General information

NPI: 1770384547
Provider Name (Legal Business Name): AMELIA LAZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 NW 17TH ST
DORAL FL
33126-1025
US

IV. Provider business mailing address

4677 NW 9TH ST APT 204
MIAMI FL
33126-2325
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-5542
  • Fax:
Mailing address:
  • Phone: 305-587-6813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: