Healthcare Provider Details

I. General information

NPI: 1679921688
Provider Name (Legal Business Name): LAZARA SUAREZ MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 5TH AVE N
SAINT PETERSBURG FL
33713-7521
US

IV. Provider business mailing address

4829 ALVARADO DR
TAMPA FL
33634-6239
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2273
  • Fax:
Mailing address:
  • Phone: 201-508-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: