Healthcare Provider Details

I. General information

NPI: 1699776534
Provider Name (Legal Business Name): GABRIEL GEORGE LAZCANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 SW 37TH AVE
MIAMI FL
33145-1754
US

IV. Provider business mailing address

1661 SW 37TH AVE
MIAMI FL
33145-1754
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-2400
  • Fax: 305-461-2902
Mailing address:
  • Phone: 305-461-2400
  • Fax: 305-461-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME77719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: