MEDICARE: MARCELA A LAZO 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
1	174400000X	Specialist
2	207V00000X	Obstetrics & Gynecology Physician	ME110131	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LN461	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	14FW0	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629262126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELA A LAZO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 25317
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-5317
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:	813-282-1806

Provider Business Practice Location Address
First Line	:	4671 S CONGRESS AVE
Second Line	:	SUITE 100B
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4783
Country	:	US
Telephone Number	:	561-434-0111
Fax Number	:	561-296-3533

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	09/18/2019

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Directions to “ MARCELA A LAZO M.D.” Practice Location

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