Provider Demographics
NPI:1215401690
Name:PEREZ CARDONELL, LAZARA IBELICE
Entity type:Individual
Prefix:
First Name:LAZARA
Middle Name:IBELICE
Last Name:PEREZ CARDONELL
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 1:231 SW 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1143
Mailing Address - Country:US
Mailing Address - Phone:786-678-5436
Mailing Address - Fax:
Practice Address - Street 1:231 SW 54TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1143
Practice Address - Country:US
Practice Address - Phone:786-678-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care