Provider Demographics
NPI:1033395124
Name:VILLAFRANCA, LAZERO D ENEYDO (CST)
Entity Type:Individual
Prefix:MR
First Name:LAZERO
Middle Name:D ENEYDO
Last Name:VILLAFRANCA
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:STONEMOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30086
Mailing Address - Country:US
Mailing Address - Phone:770-761-9508
Mailing Address - Fax:
Practice Address - Street 1:622 PENNYLAKE LANE
Practice Address - Street 2:
Practice Address - City:STONEMOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5768
Practice Address - Country:US
Practice Address - Phone:770-761-9508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist