Healthcare Provider Details

I. General information

NPI: 1760227979
Provider Name (Legal Business Name): LAZARO MATIAS RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12456 SW 127TH AVE FL 2
MIAMI FL
33186-6596
US

IV. Provider business mailing address

3700 SW 91ST AVE
MIAMI FL
33165-4363
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-8500
  • Fax:
Mailing address:
  • Phone: 786-674-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: