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General NPI Number Information
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NPI Number | 1336442441
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Entity Type | Organization
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Legal Business Name | VICENTE LAGO M.D. P.A.
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 351 NW 42ND AVE STE 305
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City | MIAMI
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State | FL
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Zip | 33126-5683
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Country | US
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Telephone | 305-541-1041
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Fax | 305-541-7762
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Provider Business Mailing Address
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Address Line | 351 NW 42ND AVE STE 305
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City | MIAMI
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State | FL
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Zip | 33126-5683
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Country | US
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Telephone | 305-541-1041
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Fax | 305-541-7762
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICENTE LAGO
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Credential | M.D.
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Telephone | 305-541-1041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0024854
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License Number State | FL
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