Healthcare Provider Details

I. General information

NPI: 1962084475
Provider Name (Legal Business Name): YENEY LAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21364 NW 40TH CIRCLE CT
MIAMI GARDENS FL
33055-1146
US

IV. Provider business mailing address

21364 NW 40TH CIRCLE CT
MIAMI GARDENS FL
33055-1146
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-6948
  • Fax:
Mailing address:
  • Phone: 786-663-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-140396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: