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General NPI Number Information
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NPI Number | 1295522944
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Entity Type | Individual
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Provider Name | CARLOS MANUEL LEZCANO III
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Gender | Male
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 8900 N KENDALL DR # 2-SOUTH
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City | MIAMI
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State | FL
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Zip | 33176-2118
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Country | US
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Telephone | 305-783-7982
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Fax |
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Provider Business Mailing Address
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Address Line | 12952 NW 18TH CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2510
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Country | US
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Telephone | 954-778-1664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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