Provider Demographics
NPI:1740935444
Name:THE LAJAS MEDICAL GROUP INC.
Entity type:Organization
Organization Name:THE LAJAS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:PUPO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-353-3446
Mailing Address - Street 1:6005 N THATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5536
Mailing Address - Country:US
Mailing Address - Phone:727-353-3446
Mailing Address - Fax:727-353-3447
Practice Address - Street 1:6601 MEMORIAL HWY STE 112
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4501
Practice Address - Country:US
Practice Address - Phone:727-353-3446
Practice Address - Fax:727-353-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty