Provider Demographics
NPI:1720316037
Name:LAGO, LOURDES ROXANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:ROXANA
Last Name:LAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2543
Mailing Address - Country:US
Mailing Address - Phone:305-823-8510
Mailing Address - Fax:305-823-8530
Practice Address - Street 1:1999 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2543
Practice Address - Country:US
Practice Address - Phone:305-823-8510
Practice Address - Fax:305-823-8530
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12,504I207R00000X
FLME1167002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine