Healthcare Provider Details

I. General information

NPI: 1184796369
Provider Name (Legal Business Name): IVAN LAFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9847 SW 40TH ST
MIAMI FL
33165-3993
US

IV. Provider business mailing address

11441 SW 5TH ST
MIAMI FL
33174-1050
US

V. Phone/Fax

Practice location:
  • Phone: 305-226-2525
  • Fax:
Mailing address:
  • Phone: 305-226-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: