Healthcare Provider Details

I. General information

NPI: 1710161427
Provider Name (Legal Business Name): ORLIN LAZAROV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1854 OTOWI DR
SANTA FE NM
87505-3301
US

IV. Provider business mailing address

PO BOX 47311
TAMPA FL
33646-0137
US

V. Phone/Fax

Practice location:
  • Phone: 813-335-7163
  • Fax:
Mailing address:
  • Phone: 813-335-7163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3653
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: