Healthcare Provider Details

I. General information

NPI: 1285438515
Provider Name (Legal Business Name): JERLYN LAZA FLEITES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 PALM HILL DR APT B112
WEST PALM BEACH FL
33415-7400
US

IV. Provider business mailing address

5020 PALM HILL DR APT B112
WEST PALM BEACH FL
33415-7400
US

V. Phone/Fax

Practice location:
  • Phone: 305-984-7012
  • Fax:
Mailing address:
  • Phone: 305-984-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberBACB583630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: