Healthcare Provider Details

I. General information

NPI: 1437905965
Provider Name (Legal Business Name): RITO LAZARRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W EAU GALLIE BLVD STE 203
MELBOURNE FL
32935-4149
US

IV. Provider business mailing address

1751 MACKLIN ST NW
PALM BAY FL
32907-8073
US

V. Phone/Fax

Practice location:
  • Phone: 321-987-0041
  • Fax:
Mailing address:
  • Phone: 321-557-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: