Basic Information
Provider Information | |||||||||
NPI: | 1558821025 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LAZU ARROYO | ||||||||
FirstName: | CARLOS | ||||||||
MiddleName: | ALBERTO | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MBA, MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LAZU ARROYO | ||||||||
OtherFirstName: | CARLOS | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | HC 6 BOX 11354 | ||||||||
Address2: |   | ||||||||
City: | YABUCOA | ||||||||
State: | PR | ||||||||
PostalCode: | 007679750 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9393326696 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 917 AVE TITO CASTRO | ||||||||
Address2: |   | ||||||||
City: | PONCE | ||||||||
State: | PR | ||||||||
PostalCode: | 007164717 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7878442080 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/21/2019 | ||||||||
LastUpdateDate: | 12/21/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/21/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 22145 | PR | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 22145 | 01 | PR | STATE LICENSE | OTHER |