| San Lazaro Medical Group, Inc | |
|
3271 Nw 7th St Ste 211 Miami FL 33125-4141 | |
| (786) 294-0442 | |
| (786) 294-0124 |
| Full Name | San Lazaro Medical Group, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3271 Nw 7th St Ste 211, Miami, Florida |
| Authorized Official Name and Position | Nidia D Dominguez (VICE PRESIDENT) |
| Authorized Official Contact | 7862940442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Lazaro Medical Group, Inc 3271 Nw 7th St Ste 211 Miami FL 33125-4141 Ph: (786) 294-0442 | San Lazaro Medical Group, Inc 3271 Nw 7th St Ste 211 Miami FL 33125-4141 Ph: (786) 294-0442 |
| NPI Number | 1790231728 |
|---|---|
| Provider Enumeration Date | 08/30/2016 |
| Last Update Date | 01/29/2021 |
| Medicare PECOS PAC ID | 8123395027 |
|---|---|
| Medicare Enrollment ID | O20170524002680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790231728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Nidia D Dominguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396190302 PECOS PAC ID: 6507140514 Enrollment ID: I20170310000479 |
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