Basic Information
| Provider Information | |||||||||
| NPI: | 1376715441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LASCANO | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8400 NW 33RD ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331221937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446654827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 NW 87TH AVE | ||||||||
| Address2: | SUITE 101 AND 201 | ||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331722654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057189138 | ||||||||
| FaxNumber: | 3057189191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2008 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | ME 103606 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QA0505X | ME 103606 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.