Provider Demographics
NPI:1033497375
Name:LAKES AMBULATORY SURGICAL CENTER
Entity Type:Organization
Organization Name:LAKES AMBULATORY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-556-8353
Mailing Address - Street 1:15600 NW 67TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2175
Mailing Address - Country:US
Mailing Address - Phone:305-556-8353
Mailing Address - Fax:305-827-2415
Practice Address - Street 1:15600 NW 67TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2175
Practice Address - Country:US
Practice Address - Phone:305-556-8353
Practice Address - Fax:305-827-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical