Healthcare Provider Details

I. General information

NPI: 1437158953
Provider Name (Legal Business Name): JOSE LAZAGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVE PINERO
SAN JUAN PR
00918-4049
US

IV. Provider business mailing address

300 AVE PINERO
SAN JUAN PR
00918-4049
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-9196
  • Fax: 787-758-8280
Mailing address:
  • Phone: 787-758-9196
  • Fax: 787-758-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2925
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: