Healthcare Provider Details

I. General information

NPI: 1164361085
Provider Name (Legal Business Name): BEATRIZ DE LA CARIDAD LAGO MARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 SE 2ND PL
HIALEAH FL
33010-5509
US

IV. Provider business mailing address

954 SE 2ND PL
HIALEAH FL
33010-5509
US

V. Phone/Fax

Practice location:
  • Phone: 954-768-3454
  • Fax:
Mailing address:
  • Phone: 954-768-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-506849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: