Provider Demographics
NPI:1841715950
Name:LAZO QUINTANA, ISARELYS
Entity type:Individual
Prefix:DR
First Name:ISARELYS
Middle Name:
Last Name:LAZO QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 NW 7TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2225
Mailing Address - Country:US
Mailing Address - Phone:786-897-4878
Mailing Address - Fax:
Practice Address - Street 1:4789 SW 148TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2121
Practice Address - Country:US
Practice Address - Phone:954-252-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN226531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice