Provider Demographics
NPI:1518260454
Name:LAJARA, AIXA E (MD)
Entity Type:Individual
Prefix:
First Name:AIXA
Middle Name:E
Last Name:LAJARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:078-450-3304
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:7714 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-8422
Practice Address - Country:US
Practice Address - Phone:407-745-4581
Practice Address - Fax:407-745-4583
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18799208D00000X
FLACN802208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP979938OtherOPTIMUM
FLP01805021OtherSIMPLY
FL1133316OtherCAREPLUS
FLP1043313OtherFREEDOM
PR18799OtherLICENSE
FLA8I0GOtherFLORIDA BLUE
FLACN802OtherMEDICAL LIC
FL1230723OtherWELLCARE