Provider Demographics
NPI:1134300031
Name:M C LACAYO MD PA
Entity Type:Organization
Organization Name:M C LACAYO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:LACAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-338-8320
Mailing Address - Street 1:6623 NW 23RD TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3634
Mailing Address - Country:US
Mailing Address - Phone:561-338-8320
Mailing Address - Fax:
Practice Address - Street 1:6623 NW 23RD TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3634
Practice Address - Country:US
Practice Address - Phone:561-338-8320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47330207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty