MEDICARE: DR. LUIS G ACEVEDO LAZZARINI MD

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	207X00000X	Orthopaedic Surgery Physician	4597	PR

General Provider Information

NPI Number	:	1104825983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS G ACEVEDO LAZZARINI MD

Provider Business Mailing Address
First Line	:	PO BOX 1868
Second Line	:	VICTORIA STATION
City	:	AGUADILLA
State	:	PR
Zip	:	00605-1868
Country	:	US
Telephone Number	:	787-819-1215
Fax Number	:	787-819-4902

Provider Business Practice Location Address
First Line	:	HOSPITAL BUEN SAMARITANO
Second Line	:	AVE KENNEDY #18 KM 1411
City	:	AGUADILLA
State	:	PR
Zip	:	00605
Country	:	US
Telephone Number	:	787-819-0800
Fax Number	:

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/04/2013

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