Provider Demographics
NPI:1548270556
Name:LAZARO, NANCY MARLENE (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MARLENE
Last Name:LAZARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7608
Mailing Address - Country:US
Mailing Address - Phone:561-432-5849
Mailing Address - Fax:561-283-0677
Practice Address - Street 1:2330 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7608
Practice Address - Country:US
Practice Address - Phone:561-432-5849
Practice Address - Fax:561-283-0677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14703208000000X
FLACN714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015800900Medicaid