MEDICARE: SAN LAZARO HOME HEALTH, INC.

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	251E00000X	Home Health Agency	299992635	FL

General Provider Information

NPI Number	:	1679699433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN LAZARO HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	6625 MIAMI LAKES DR
Second Line	:	SUITES 342 & 310
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2708
Country	:	US
Telephone Number	:	305-642-5009
Fax Number	:

Provider Business Practice Location Address
First Line	:	6625 MIAMI LAKES DR
Second Line	:	SUITES 342 & 310
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2708
Country	:	US
Telephone Number	:	305-777-3882
Fax Number	:	305-777-3885

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MIRENA MONZON
Credential	:
Telephone Number	:	305-777-3882

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	11/27/2013

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