Provider Demographics
NPI:1265037691
Name:LEZCANO VENTO, HAILYS
Entity Type:Individual
Prefix:MISS
First Name:HAILYS
Middle Name:
Last Name:LEZCANO VENTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 BAY HARBOR TER APT 3A
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2733
Mailing Address - Country:US
Mailing Address - Phone:305-790-3082
Mailing Address - Fax:
Practice Address - Street 1:1460 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4617
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:305-504-8868
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11008529363LF0000X
FL11008529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily