Basic Information
| Provider Information | |||||||||
| NPI: | 1972579779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELGADO | ||||||||
| FirstName: | LAZARO | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3885 OAKWATER CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078515600 | ||||||||
| FaxNumber: | 4074389585 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078515600 | ||||||||
| FaxNumber: | 4074389585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 10/21/2009 | ||||||||
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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 | 207RN0300X | ME87494 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 266641300 | 05 | FL | MEDICAID | 7886327 | 01 | FL | AETNA | OTHER | 2301077 | 01 | FL | UNITED HEALTHCARE | OTHER | 79357 | 01 | FL | BC/BS | OTHER |