Provider Demographics
NPI:1932442399
Name:FUENTES LAZZARINI, ANDRES A (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:A
Last Name:FUENTES LAZZARINI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 HACIENDA LA REFORMA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-5732
Mailing Address - Country:US
Mailing Address - Phone:787-240-3672
Mailing Address - Fax:
Practice Address - Street 1:1430 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2134
Practice Address - Country:US
Practice Address - Phone:772-785-8500
Practice Address - Fax:772-785-8511
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor