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NPI Code Detail

MEDICARE: MARIANO S. LACAYO M.D.

MEDICARE: MARIANO S. LACAYO M.D.
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
1207R00000XInternal Medicine PhysicianME89783FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131138OTHERFLBCBS
2ME89783OTHERFLMEDICAL LICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164463691
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANO S. LACAYO M.D.
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 305-500-2000
Fax Number :
Provider Business Practice Location Address
First Line : 975 W 49TH ST
Second Line :
City : HIALEAH
State : FL
Zip : 33012-3412
Country : US
Telephone Number : 786-281-5358
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 09/02/2022

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