Healthcare Provider Details

I. General information

NPI: 1013225952
Provider Name (Legal Business Name): LAZARO H CORDOVES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 NW 173RD DR SUITE 7
HIALEAH FL
33015-5112
US

IV. Provider business mailing address

5951 NW 173RD DR SUITE 7
HIALEAH FL
33015-5112
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-1030
  • Fax: 305-557-9757
Mailing address:
  • Phone: 305-557-1030
  • Fax: 305-557-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME84853
License Number StateFL

VIII. Authorized Official

Name: DR. LAZARO H CORDOVES
Title or Position: OWNER
Credential: MD
Phone: 305-557-1030