Provider Demographics
NPI:1376304568
Name:LANZAS, JEFFERSON JOSE
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:JOSE
Last Name:LANZAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 E 9TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1713
Mailing Address - Country:US
Mailing Address - Phone:786-872-2599
Mailing Address - Fax:
Practice Address - Street 1:4925 E 9TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1713
Practice Address - Country:US
Practice Address - Phone:786-872-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician