Basic Information
| Provider Information | |||||||||
| NPI: | 1740888569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELTRAN | ||||||||
| FirstName: | LAZARO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 NW 25TH ST | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331721416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055973861 | ||||||||
| FaxNumber: | 3055973861 | ||||||||
| Practice Location | |||||||||
| Address1: | 9600 NW 25TH ST | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331721416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055973861 | ||||||||
| FaxNumber: | 3055973861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2020 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-20-132999 | FL | Y |
No ID Information.