LAZARO FRAGA MD PA
Medical Practice at 6 St, Miami, FL

License number
Florida 279233800
Category
Medical Practice
Type
Pediatrics
Owner
Name: RENE CASANOVA MD
Title: MEDICAL DIRECTOR
Phone: (305) 363-3675
Address
Address
4131 SW 6Th St, Miami, FL 33134
National Provider ID: 1245413905
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LAZARO FRAGA, M.D., PA

Miami, FL

Status:
Inactive
Industry:
Pediatrician, Family Doctor
Doing business as:
Lazaro Fraga MD PA
Inactive reason:
CANCEL ADM DISS/REV
Registration:
Jul 26, 1990
Inactive since:
Oct 9, 2007
Phone:
(305) 443-5031 (Phone)
Addresses:
4141 SW 6 St, Miami, FL 33134 (Physical)
4131 SW 6, Miami, FL 33134 (Mailing)
State ID:
L92581
Business type:
Florida Profit Corporation
Rene M.d. Casanova
Agent:
Bradford Beilly,1144 SE 3 Ave, Fort Lauderdale, FL 33316 (Physical)
EIN:
650212954

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