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General NPI Number Information
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NPI Number | 1629233515
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Entity Type | Individual
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Provider Name | LARISSA LEMBERT-TEZANOS MD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 2201 45TH ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2047
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Country | US
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Telephone | 561-842-6141
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 144333
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City | ORLANDO
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State | FL
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Zip | 32814-4333
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Country | US
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Telephone | 407-422-9831
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME103678
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License Number State | FL
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