Provider Demographics
NPI:1659574440
Name:LASSALLE, CARLOS CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:CESAR
Last Name:LASSALLE
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 1:8312 BELFRY PL
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3017
Mailing Address - Country:US
Mailing Address - Phone:305-494-3811
Mailing Address - Fax:
Practice Address - Street 1:8312 BELFRY PL
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3017
Practice Address - Country:US
Practice Address - Phone:305-494-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108210207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology