Healthcare Provider Details

I. General information

NPI: 1326760687
Provider Name (Legal Business Name): MIGUEL LAZO ALVAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 SW 208TH ST
MIAMI FL
33177-5712
US

IV. Provider business mailing address

11801 SW 208TH ST
MIAMI FL
33177-5712
US

V. Phone/Fax

Practice location:
  • Phone: 786-865-0997
  • Fax:
Mailing address:
  • Phone: 786-865-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: