Basic Information
Provider Information
NPI: 1538276134
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABREU-LANFRANCO
FirstName: ODALIZ
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: SAINT RAPHAEL FACULTY PHYSICIANS
Address2: PO BOX 18263
City: BRIDEPORT
State: CT
PostalCode: 066013263
CountryCode: US
TelephoneNumber: 5085950531
FaxNumber: 5088295367
Practice Location
Address1: SAINT RAPHAEL FACULTY PHYSICIANS
Address2: 1450 CHAPEL STREET
City: NEW HAVEN
State: CT
PostalCode: 06511
CountryCode: US
TelephoneNumber: 2037894074
FaxNumber: 2038675534
Other Information
ProviderEnumerationDate: 08/23/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X044596CTY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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