Provider Demographics
NPI:1629673421
Name:ABREU CAMPO, LAZARO E
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:E
Last Name:ABREU CAMPO
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 1:224 DATURA ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5624
Mailing Address - Country:US
Mailing Address - Phone:561-461-9669
Mailing Address - Fax:
Practice Address - Street 1:224 DATURA ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5624
Practice Address - Country:US
Practice Address - Phone:561-461-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies