San Lazaro Medical Group, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SAN LAZARO MEDICAL GROUP, INC

Practice address

3271 NW 7TH St Ste 211
Miami, FL 33125-4141

Phone

(786) 294-0442

Fax

(786) 294-0124

NPI assigned

Aug 30, 2016

Last updated

Jan 29, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Nidia D Dominguez, APRNNPI 1396190302

Title

Vice President

Phone

(786) 294-0442

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nidia D Dominguez, ARNP

  • Family Nurse Practitioner
  • Miami, FL
  • NPI 1396190302
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611878400000",
    "number": "1790231728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3271 NW 7TH ST STE 211",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331254141",
            "telephone_number": "786-294-0442",
            "fax_number": "786-294-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3271 NW 7TH ST STE 211",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331254141",
            "telephone_number": "786-294-0442",
            "fax_number": "786-294-0124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5803 NW 151st St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Miami Lakes",
            "state": "FL",
            "postal_code": "330142473",
            "country_code": "US",
            "telephone_number": "786-294-0442",
            "fax_number": "786-294-0124",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 SW 1st St",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331351960",
            "country_code": "US",
            "telephone_number": "305-342-3258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN LAZARO MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-30",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "NIDIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "786-294-0442",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pedro Pablo San Martin Parra, MD
• Vanessa Amelia San Martin-Diaz

• Family Medicine Physician in Miami, FL
• Providers in Miami, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.