Healthcare Provider Details

I. General information

NPI: 1679696785
Provider Name (Legal Business Name): MARTIN ALEJANDRO LAFATA D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E 1ST AVE
HIALEAH FL
33010-4909
US

IV. Provider business mailing address

8850 SW 123RD CT APT H210
MIAMI FL
33186-4151
US

V. Phone/Fax

Practice location:
  • Phone: 305-863-8887
  • Fax:
Mailing address:
  • Phone: 305-218-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH 9012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: