Basic Information
| Provider Information | |||||||||
| NPI: | 1861688483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALVINO ACOSTA | ||||||||
| FirstName: | LAZARO | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8600 NW 41ST ST | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331666202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056425366 | ||||||||
| FaxNumber: | 3056313828 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 E 25TH ST | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330133810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056425366 | ||||||||
| FaxNumber: | 3056313828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 09/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 26447R | PR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME106274 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.