Provider Demographics
NPI:1699026609
Name:EDUARDO LAVADO MD PA
Entity Type:Organization
Organization Name:EDUARDO LAVADO MD PA
Other - Org Name:EDUARDO LAVADO MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-822-4562
Mailing Address - Street 1:4160 W 16TH AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5853
Mailing Address - Country:US
Mailing Address - Phone:305-822-4562
Mailing Address - Fax:
Practice Address - Street 1:4160 W 16TH AVE STE 406
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5853
Practice Address - Country:US
Practice Address - Phone:305-822-4562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20778207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058812100Medicaid
FL058812100Medicaid