1871614511 NPI number — ABELARDO V. LACANO, MD, PA

Table of content: (NPI 1871614511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871614511 NPI number — ABELARDO V. LACANO, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABELARDO V. LACANO, MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871614511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 FORTENBERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRITT ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32952-3621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-452-8410
Provider Business Mailing Address Fax Number:
321-453-4938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 FORTENBERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRITT ISLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32952-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-452-8410
Provider Business Practice Location Address Fax Number:
321-453-4938
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LACANO
Authorized Official First Name:
ABELARDO
Authorized Official Middle Name:
VASQUEZ
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-452-8410

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME 20168 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05312 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4205733 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com