Healthcare Provider Details

I. General information

NPI: 1548270556
Provider Name (Legal Business Name): NANCY MARLENE LAZARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 S CONGRESS AVE
PALM SPRINGS FL
33406-7608
US

IV. Provider business mailing address

2330 S CONGRESS AVE
PALM SPRINGS FL
33406-7608
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-5849
  • Fax: 561-283-0677
Mailing address:
  • Phone: 561-432-5849
  • Fax: 561-283-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14703
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberACN714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: