Provider Demographics
NPI:1649390774
Name:LASA, VICTOR (DC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:LASA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12278 E COLONIAL DR
Mailing Address - Street 2:SUTIE 700
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4738
Mailing Address - Country:US
Mailing Address - Phone:407-273-7727
Mailing Address - Fax:407-273-7718
Practice Address - Street 1:12278 E COLONIAL DR
Practice Address - Street 2:SUTIE 700
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4738
Practice Address - Country:US
Practice Address - Phone:407-273-7727
Practice Address - Fax:407-273-7718
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor