Provider Demographics
NPI:1285438515
Name:LAZA FLEITES, JERLYN
Entity type:Individual
Prefix:
First Name:JERLYN
Middle Name:
Last Name:LAZA FLEITES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 PALM HILL DR
Mailing Address - Street 2:APT B112
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7400
Mailing Address - Country:US
Mailing Address - Phone:305-984-7012
Mailing Address - Fax:
Practice Address - Street 1:5020 PALM HILL DR APT B112
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7400
Practice Address - Country:US
Practice Address - Phone:305-984-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB583630202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner