Provider Demographics
NPI:1386786622
Name:LANA MEDICAL CARE P.A.
Entity type:Organization
Organization Name:LANA MEDICAL CARE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRAZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-676-2779
Mailing Address - Street 1:500 MEMORIAL CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5071
Mailing Address - Country:US
Mailing Address - Phone:386-676-2779
Mailing Address - Fax:376-676-2811
Practice Address - Street 1:500 MEMORIAL CIR
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5071
Practice Address - Country:US
Practice Address - Phone:386-676-2779
Practice Address - Fax:376-676-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4286Medicare ID - Type Unspecified