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NPI Code Detail

MEDICARE: JORGE MANUEL LAZO DE LA VEGA

MEDICARE: JORGE MANUEL LAZO DE LA VEGA
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
1106S00000XBehavior TechnicianRBT-23-259401FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336849710
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE MANUEL LAZO DE LA VEGA
Provider Business Mailing Address
First Line : 1483 W 44TH TER
Second Line :
City : HIALEAH
State : FL
Zip : 33012-7675
Country : US
Telephone Number : 786-609-5043
Fax Number : 561-634-2814
Provider Business Practice Location Address
First Line : 7971 RIVIERA BLVD STE 203
Second Line :
City : MIRAMAR
State : FL
Zip : 33023-6446
Country : US
Telephone Number : 786-508-3245
Fax Number : 561-634-2814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2023
Last Update Date : 04/02/2026

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Directions to “ JORGE MANUEL LAZO DE LA VEGA ” Practice Location

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