Provider Demographics
NPI:1841732963
Name:LAU, ANDRES OMAR (CSA)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:OMAR
Last Name:LAU
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15579 MIAMI LAKEWAY N APT 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5588
Mailing Address - Country:US
Mailing Address - Phone:786-603-4750
Mailing Address - Fax:
Practice Address - Street 1:15579 MIAMI LAKEWAY N APT 105
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5588
Practice Address - Country:US
Practice Address - Phone:786-603-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16670246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant