Healthcare Provider Details

I. General information

NPI: 1104634203
Provider Name (Legal Business Name): LAZARA ISEL LLANES GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 CARIBBEAN BLVD STE 101
CUTLER BAY FL
33189-1224
US

IV. Provider business mailing address

19060 NW 78TH AVE
HIALEAH FL
33015-2755
US

V. Phone/Fax

Practice location:
  • Phone: 305-589-4739
  • Fax:
Mailing address:
  • Phone: 305-589-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: