1518260454 NPI number — AIXA E LAJARA M.D

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518260454 NPI number — AIXA E LAJARA M.D

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LAJARA

Provider First Name:

AIXA

Provider Middle Name:

E

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D

Provider Gender Code:

F

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:

1518260454

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/23/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6675 WESTWOOD BLVD STE 475

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ORLANDO

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

32821-6027

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

78-450-3304

Provider Business Mailing Address Fax Number:

888-972-1752

Provider First Line Business Practice Location Address:

7714 E COLONIAL DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ORLANDO

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

32807-8422

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

407-745-4581

Provider Business Practice Location Address Fax Number:

407-745-4583

Provider Enumeration Date:

12/15/2010

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208D00000X , with the licence number:  18799 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208D00000X , with the licence number: ACN802 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: P979938 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P01805021 . This is a "SIMPLY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1133316 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P1043313 . This is a "FREEDOM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 18799 . This is a "LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: A8I0G . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: ACN802 . This is a "MEDICAL LIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1230723 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 024581100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".