Provider Demographics
NPI:1952882003
Name:LANZA MEDICAL AND PULMONARY ASSOCIATES LLC
Entity Type:Organization
Organization Name:LANZA MEDICAL AND PULMONARY ASSOCIATES LLC
Other - Org Name:LANZA MEDICAL AND PULMONARY ASSOCIATES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:CRISTO
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-864-3071
Mailing Address - Street 1:9105 TILLINGHAST DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1625
Mailing Address - Country:US
Mailing Address - Phone:718-864-3071
Mailing Address - Fax:
Practice Address - Street 1:9105 TILLINGHAST DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1625
Practice Address - Country:US
Practice Address - Phone:718-864-3071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128187207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty