Healthcare Provider Details

I. General information

NPI: 1902330459
Provider Name (Legal Business Name): GREILYS LAZCANO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 06/07/2020
Certification Date: 06/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR
TAMPA FL
33606-3603
US

IV. Provider business mailing address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

V. Phone/Fax

Practice location:
  • Phone: 813-250-2177
  • Fax: 813-250-2790
Mailing address:
  • Phone: 813-681-5551
  • Fax: 813-916-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: