Healthcare Provider Details

I. General information

NPI: 1629262126
Provider Name (Legal Business Name): MARCELA A LAZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 S CONGRESS AVE SUITE 100B
LAKE WORTH FL
33461-4783
US

IV. Provider business mailing address

PO BOX 25317
TAMPA FL
33622-5317
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0111
  • Fax: 561-296-3533
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME110131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: