Healthcare Provider Details

I. General information

NPI: 1609022862
Provider Name (Legal Business Name): HUMBERTO JESUS LEZCANO ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 W 21ST ST
HIALEAH FL
33010-2615
US

IV. Provider business mailing address

7452 W 29TH WAY
HIALEAH FL
33018-5334
US

V. Phone/Fax

Practice location:
  • Phone: 786-453-8720
  • Fax: 786-219-4355
Mailing address:
  • Phone: 786-444-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023919
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number16520-I
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: