Provider Demographics
NPI:1679699433
Name:SAN LAZARO HOME HEALTH, INC.
Entity type:Organization
Organization Name:SAN LAZARO HOME HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-777-3882
Mailing Address - Street 1:6625 MIAMI LAKES DR
Mailing Address - Street 2:SUITES 342 & 310
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2708
Mailing Address - Country:US
Mailing Address - Phone:305-642-5009
Mailing Address - Fax:
Practice Address - Street 1:6625 MIAMI LAKES DR
Practice Address - Street 2:SUITES 342 & 310
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2708
Practice Address - Country:US
Practice Address - Phone:305-777-3882
Practice Address - Fax:305-777-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992635251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health