Individual
DR. CRISOSTOMO V LACANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 LONGWOOD AVENUE, ROCKLEDGE, FL 32955
(321) 636-2211
Mailing address
PO BOX 919346, ORLANDO, FL 32891-9346
(727) 896-3134
(770) 666-9331
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
29409
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039490400
—
FL
01
—
05401
BCBS
FL
Enumeration date
02/16/2006
Last updated
08/15/2014
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