MEDICARE: ADRIA MARIA LAZO VAZQUEZ RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-21-186383

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-21-186383	OTHER		BACB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477215671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIA MARIA LAZO VAZQUEZ RBT

Provider Business Mailing Address
First Line	:	611 SW MCCULLOUGH AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3976
Country	:	US
Telephone Number	:	772-708-0053
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 SW MCCULLOUGH AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-3976
Country	:	US
Telephone Number	:	772-708-0053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	02/26/2026

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