Healthcare Provider Details

I. General information

NPI: 1578181673
Provider Name (Legal Business Name): ALEJANDRO LAZARO GONZALEZ PEREZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12024 SW 77TH TER
MIAMI FL
33183-3764
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 786-253-4679
  • Fax:
Mailing address:
  • Phone: 323-860-5200
  • Fax: 323-467-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: