Provider Demographics
NPI:1689146383
Name:LAGOS, FABIANE
Entity type:Individual
Prefix:
First Name:FABIANE
Middle Name:
Last Name:LAGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SW TATUM TER
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2690
Mailing Address - Country:US
Mailing Address - Phone:786-357-9519
Mailing Address - Fax:
Practice Address - Street 1:715 SW TATUM TER
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2690
Practice Address - Country:US
Practice Address - Phone:786-357-9519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty