Provider Demographics
NPI:1457846032
Name:SOBRINO MORGADO, ISSAC LAZARO (SA-C)
Entity Type:Individual
Prefix:
First Name:ISSAC
Middle Name:LAZARO
Last Name:SOBRINO MORGADO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 NE 173RD ST APT 9
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2980
Mailing Address - Country:US
Mailing Address - Phone:315-395-7690
Mailing Address - Fax:
Practice Address - Street 1:2244 NE 173RD ST
Practice Address - Street 2:APT 9
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2980
Practice Address - Country:US
Practice Address - Phone:315-395-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-231246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant