Provider Demographics
NPI:1336549252
Name:LAZALA, ALEJANDRO
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:LAZALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 US HIGHWAY 1
Mailing Address - Street 2:314
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4617
Mailing Address - Country:US
Mailing Address - Phone:561-465-1600
Mailing Address - Fax:
Practice Address - Street 1:2681 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4237
Practice Address - Country:US
Practice Address - Phone:561-827-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64337175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath