Healthcare Provider Details

I. General information

NPI: 1598486730
Provider Name (Legal Business Name): CLAUDIA MILLAN LAZCANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 SW 41ST PL
DAVIE FL
33314-3408
US

IV. Provider business mailing address

6110 SW 41ST PL
DAVIE FL
33314-3408
US

V. Phone/Fax

Practice location:
  • Phone: 786-712-0402
  • Fax:
Mailing address:
  • Phone: 786-712-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-227714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: