MEDICARE: CARLOS LAZU

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1154708584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS LAZU

Provider Business Mailing Address
First Line	:	2804 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7252
Country	:	US
Telephone Number	:	239-540-8011
Fax Number	:	239-540-9011

Provider Business Practice Location Address
First Line	:	2804 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7252
Country	:	US
Telephone Number	:	239-540-8011
Fax Number	:	239-540-9011

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

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/06/2015

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Directions to “ CARLOS LAZU ” Practice Location

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