Healthcare Provider Details

I. General information

NPI: 1962623314
Provider Name (Legal Business Name): DR. BRAZELIA LAZZARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 E OAKLAND PARK BLVD SUITE 103
FT LAUDERDALE FL
33306-1664
US

IV. Provider business mailing address

2561 NW 79TH AVE
MARGATE FL
33063-8156
US

V. Phone/Fax

Practice location:
  • Phone: 954-566-5097
  • Fax: 954-414-8422
Mailing address:
  • Phone: 954-214-1065
  • Fax: 954-414-8422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: