Provider Demographics
NPI:1215328836
Name:SAS, LASZLO
Entity type:Individual
Prefix:
First Name:LASZLO
Middle Name:
Last Name:SAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 EHRLICH RD
Mailing Address - Street 2:112/A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2049
Mailing Address - Country:US
Mailing Address - Phone:813-347-2419
Mailing Address - Fax:
Practice Address - Street 1:5121 EHRLICH RD
Practice Address - Street 2:112/A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2049
Practice Address - Country:US
Practice Address - Phone:813-347-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist