Healthcare Provider Details

I. General information

NPI: 1912142852
Provider Name (Legal Business Name): ROBERTO ALFONSO LANUZA M.S., B.C.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SEMMES AVE
MOBILE AL
36604-1339
US

IV. Provider business mailing address

54 SEMMES AVE
MOBILE AL
36604-1339
US

V. Phone/Fax

Practice location:
  • Phone: 786-369-1725
  • Fax:
Mailing address:
  • Phone: 786-369-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-08-4420
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: