Provider Demographics
NPI:1538418801
Name:LANZA, ROBERT STEVEN (LMT,NCBTMB)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:LANZA
Suffix:
Gender:M
Credentials:LMT,NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14620 ESCALANTE WAY
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8279
Mailing Address - Country:US
Mailing Address - Phone:954-821-7586
Mailing Address - Fax:239-221-8305
Practice Address - Street 1:14620 ESCALANTE WAY
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8279
Practice Address - Country:US
Practice Address - Phone:954-821-7586
Practice Address - Fax:239-221-8305
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist