Provider Demographics
NPI:1497171052
Name:CASTILLO, LAZARO JR
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:CASTILLO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 SW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3865
Mailing Address - Country:US
Mailing Address - Phone:813-675-5127
Mailing Address - Fax:
Practice Address - Street 1:1440 SW 42ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-3865
Practice Address - Country:US
Practice Address - Phone:813-675-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management