Provider Demographics
NPI:1134384464
Name:MARIANO S LACAYO MD PA
Entity type:Organization
Organization Name:MARIANO S LACAYO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:S
Authorized Official - Last Name:LACAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-281-5358
Mailing Address - Street 1:PO BOX 830653
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33283-0653
Mailing Address - Country:US
Mailing Address - Phone:786-281-5358
Mailing Address - Fax:305-255-1669
Practice Address - Street 1:7821 CORAL WAY
Practice Address - Street 2:STE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6542
Practice Address - Country:US
Practice Address - Phone:786-281-5358
Practice Address - Fax:305-255-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271309800Medicaid
I07594Medicare UPIN