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General NPI Number Information
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NPI Number | 1770793846
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Entity Type | Organization
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Legal Business Name | RESIDENCIA SAN LAZARO HOME CARE CORP
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 7520 SW 92 AVE
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City | MIAMI
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State | FL
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Zip | 33173
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Country | US
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Telephone | 305-598-2554
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Fax | 305-598-2554
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Provider Business Mailing Address
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Address Line | 7520 SW 92 AVE
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City | MIAMI
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State | FL
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Zip | 33173
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Country | US
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Telephone | 305-598-2554
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Fax | 305-598-2554
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELVIRA RODRIGUEZ
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Credential |
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Telephone | 305-793-6523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL 8454
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License Number State | FL
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