Provider Demographics
NPI:1699522987
Name:CEPEDA, LAZARO ALEJANDRO
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:ALEJANDRO
Last Name:CEPEDA
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 1:4040 W WATERS AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-8133
Mailing Address - Country:US
Mailing Address - Phone:813-316-3410
Mailing Address - Fax:
Practice Address - Street 1:4040 W WATERS AVE STE 207
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-8133
Practice Address - Country:US
Practice Address - Phone:813-316-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)