Healthcare Provider Details

I. General information

NPI: 1134513070
Provider Name (Legal Business Name): LAAR CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13729 SW 15TH ST
MIAMI FL
33184-2716
US

IV. Provider business mailing address

13729 SW 15TH ST
MIAMI FL
33184-2716
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-1187
  • Fax: 305-397-2257
Mailing address:
  • Phone: 786-624-1187
  • Fax: 305-397-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFAEL CASTELLON
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 786-624-1187