Healthcare Provider Details

I. General information

NPI: 1942247234
Provider Name (Legal Business Name): ZENAIDA L LAVINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 NORMANDY BLVD SUITE 201
JACKSONVILLE FL
32221-8059
US

IV. Provider business mailing address

PO BOX 1978
MIDDLEBURG FL
32050-1978
US

V. Phone/Fax

Practice location:
  • Phone: 904-861-1034
  • Fax: 904-861-1037
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-282-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME46987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: