Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS15013 | FL |
NPI | 1003208083 |
---|---|
Provider Name | Lissette Perez Lazo |
First Address | Miami, FL 33185-4593 |
Second Address | North Miami Beach, FL 33162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2015 |
Last Update Date | 31/03/2021 |