Provider Demographics
NPI:1841173408
Name:FORNOS, LAZARO M
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:M
Last Name:FORNOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 BROAD POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-2213
Mailing Address - Country:US
Mailing Address - Phone:407-953-3607
Mailing Address - Fax:
Practice Address - Street 1:7603 BROAD POINTE DR
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-2213
Practice Address - Country:US
Practice Address - Phone:407-953-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company