Healthcare Provider Details

I. General information

NPI: 1831706803
Provider Name (Legal Business Name): IRIS JEANNETTE LAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 WILLA SPRINGS DR STE 110
WINTER SPRINGS FL
32708-5205
US

IV. Provider business mailing address

1008 WILLA SPRINGS DR STE 110
WINTER SPRINGS FL
32708-5205
US

V. Phone/Fax

Practice location:
  • Phone: 407-637-5891
  • Fax: 407-636-6205
Mailing address:
  • Phone: 407-637-5891
  • Fax: 407-636-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: