Provider Demographics
NPI:1821423575
Name:LASCAZE, GERARDA TAMARA (PA-C MMS)
Entity Type:Individual
Prefix:MISS
First Name:GERARDA
Middle Name:TAMARA
Last Name:LASCAZE
Suffix:
Gender:F
Credentials:PA-C MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 NE 137TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3513
Mailing Address - Country:US
Mailing Address - Phone:786-406-4486
Mailing Address - Fax:305-758-7979
Practice Address - Street 1:9730 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2311
Practice Address - Country:US
Practice Address - Phone:305-758-7979
Practice Address - Fax:305-758-0034
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9107294367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife