| The Lajas Medical Group Inc. | |
|
6601 Memorial Hwy Ste 112 Tampa FL 33615-4501 | |
| (727) 353-3446 | |
| (727) 353-3447 |
| Full Name | The Lajas Medical Group Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 6601 Memorial Hwy Ste 112, Tampa, Florida |
| Authorized Official Name and Position | Roger Manuel Pupo (PRESIDENT) |
| Authorized Official Contact | 7273533446 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Lajas Medical Group Inc. 6005 N Thatcher Ave Tampa FL 33614-5536 Ph: (727) 353-3446 | The Lajas Medical Group Inc. 6601 Memorial Hwy Ste 112 Tampa FL 33615-4501 Ph: (727) 353-3446 |
| NPI Number | 1740935444 |
|---|---|
| Provider Enumeration Date | 02/21/2022 |
| Last Update Date | 07/13/2023 |
| Medicare PECOS PAC ID | 8123415205 |
|---|---|
| Medicare Enrollment ID | O20220419001793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740935444 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Columbia V Cardenas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417262569 PECOS PAC ID: 5597987875 Enrollment ID: I20141121000930 |
| Provider Name | Roger Manuel Pupo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043908619 PECOS PAC ID: 3476703372 Enrollment ID: I20230518000318 |
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