Healthcare Provider Details

I. General information

NPI: 1023083102
Provider Name (Legal Business Name): L. P. MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7374 SW 93RD AVE SUITE 201
MIAMI FL
33173-5201
US

IV. Provider business mailing address

7374 SW 93RD AVE SUITE 201
MIAMI FL
33173-5201
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-7771
  • Fax: 305-388-7288
Mailing address:
  • Phone: 305-270-7771
  • Fax: 305-388-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME63386
License Number StateFL

VIII. Authorized Official

Name: DR. LUCAS PORRELLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-270-7771