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General NPI Number Information
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NPI Number | 1659761492
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Entity Type | Organization
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Legal Business Name | LAZARO MEDICAL INC.
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE STE 450
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City | DORAL
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State | FL
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Zip | 33166-6573
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Country | US
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Telephone | 786-229-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE STE 450
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City | DORAL
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State | FL
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Zip | 33166-6573
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Country | US
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Telephone | 786-229-3674
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAZARO GONZALEZ
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Credential |
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Telephone | 786-229-3674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | ME14277
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License Number State | FL
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