Healthcare Provider Details

I. General information

NPI: 1851995740
Provider Name (Legal Business Name): ELIOVER LAZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 NW 99TH ST
MIAMI FL
33147-2558
US

IV. Provider business mailing address

2106 NW 99TH ST
MIAMI FL
33147-2558
US

V. Phone/Fax

Practice location:
  • Phone: 941-623-7965
  • Fax:
Mailing address:
  • Phone: 941-623-7965
  • 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: