Provider Demographics
NPI:1568436665
Name:LACAYO, MARTA CECILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:CECILIA
Last Name:LACAYO
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 1:6623 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:561-443-7288
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:561-443-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine