Provider Demographics
NPI:1447717467
Name:SAN LAZARO TRANSPORTATION LLC
Entity type:Organization
Organization Name:SAN LAZARO TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRIVER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-330-8211
Mailing Address - Street 1:1031 LANDSTAR PARK DR APT 305
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-8669
Mailing Address - Country:US
Mailing Address - Phone:321-330-8211
Mailing Address - Fax:
Practice Address - Street 1:215 CELEBRATION PL STE 520
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5422
Practice Address - Country:US
Practice Address - Phone:321-330-8211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)