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General NPI Number Information
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NPI Number | 1790231728
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Entity Type | Organization
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Legal Business Name | SAN LAZARO MEDICAL GROUP, INC
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 01/29/2021
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Provider Practice Location Address
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Address Line | 3271 NW 7TH ST STE 211
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City | MIAMI
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State | FL
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Zip | 33125-4141
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Country | US
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Telephone | 786-294-0442
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Fax | 786-294-0124
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Provider Business Mailing Address
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Address Line | 3271 NW 7TH ST STE 211
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City | MIAMI
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State | FL
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Zip | 33125-4141
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Country | US
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Telephone | 786-294-0442
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Fax | 786-294-0124
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. NIDIA D DOMINGUEZ
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Credential | APRN
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Telephone | 786-294-0442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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