MEDICARE: LIUDMILA LAZO RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11029664	FL

General Provider Information

NPI Number	:	1083449102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIUDMILA LAZO RODRIGUEZ

Provider Business Mailing Address
First Line	:	5288 NW 193RD LN
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1635
Country	:	US
Telephone Number	:	786-372-4997
Fax Number	:

Provider Business Practice Location Address
First Line	:	5288 NW 193RD LN
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1635
Country	:	US
Telephone Number	:	786-372-4997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/06/2024

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