Provider Demographics
NPI:1588635130
Name:PLASENCIA, LAZARO N (MD)
Entity Type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:N
Last Name:PLASENCIA
Suffix:
Gender:M
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:PO BOX 141877
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33114-1877
Mailing Address - Country:US
Mailing Address - Phone:305-662-5200
Mailing Address - Fax:305-284-7942
Practice Address - Street 1:9740 S. W. 40 ST.
Practice Address - Street 2:SUITE #3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165
Practice Address - Country:US
Practice Address - Phone:305-227-5300
Practice Address - Fax:305-222-2851
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044812500Medicaid
FLD50621Medicare UPIN
FL044812500Medicaid