Provider Demographics
NPI:1366247181
Name:CARBONELL LAZO, TOMAS ANTONIO (SA-C)
Entity type:Individual
Prefix:
First Name:TOMAS
Middle Name:ANTONIO
Last Name:CARBONELL LAZO
Suffix:
Gender:
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8255 SUNBURY LN APT 408
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2420
Mailing Address - Country:US
Mailing Address - Phone:346-507-7748
Mailing Address - Fax:
Practice Address - Street 1:8255 SUNBURY LN APT 408
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2420
Practice Address - Country:US
Practice Address - Phone:346-507-7748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25-154246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant