Healthcare Provider Details

I. General information

NPI: 1225249709
Provider Name (Legal Business Name): JUAN C LEZCANO CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NW 29TH ST
MIAMI FL
33127-3951
US

IV. Provider business mailing address

7592 NW 3RD ST
MIAMI FL
33126-4108
US

V. Phone/Fax

Practice location:
  • Phone: 305-573-8172
  • Fax: 305-573-9575
Mailing address:
  • Phone: 786-315-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number280101040359392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: