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General NPI Number Information
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NPI Number | 1134300031
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Entity Type | Organization
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Legal Business Name | M C LACAYO MD PA
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 6623 NW 23RD TER
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City | BOCA RATON
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State | FL
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Zip | 33496-3634
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Country | US
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Telephone | 561-338-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 6623 NW 23RD TER
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City | BOCA RATON
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State | FL
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Zip | 33496-3634
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Country | US
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Telephone | 561-338-8320
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTHA CECILIA LACAYO
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Credential | MD
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Telephone | 561-338-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME47330
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License Number State | FL
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