Healthcare Provider Details

I. General information

NPI: 1972300093
Provider Name (Legal Business Name): LSJ TECHNICIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 36TH ST APT 1101
MIAMI FL
33127-3154
US

IV. Provider business mailing address

500 NW 36TH ST APT 1101
MIAMI FL
33127-3154
US

V. Phone/Fax

Practice location:
  • Phone: 954-636-9369
  • Fax:
Mailing address:
  • Phone: 954-636-9369
  • 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: GABRIELA VILLAZON PEREZ
Title or Position: OWNER
Credential:
Phone: 954-636-9369