Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN23704 | FL |
NPI | 1053705624 |
---|---|
Provider Name | Dr. Juan Carlos Lazo |
First Address | Hialeah, FL 33015-2621 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2015 |
Last Update Date | 27/01/2022 |