Provider Demographics
NPI:1588439251
Name:LAZARTE, MARIA VICTORIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:LAZARTE
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 1:5813 SW 140TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1130
Mailing Address - Country:US
Mailing Address - Phone:786-816-2130
Mailing Address - Fax:
Practice Address - Street 1:5813 SW 140TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1130
Practice Address - Country:US
Practice Address - Phone:786-816-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily