Healthcare Provider Details

I. General information

NPI: 1861278442
Provider Name (Legal Business Name): LAZARO ENRIQUE CRUZ LABORI APRN PMHNP BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

11704 NW 11TH AVE
MIAMI FL
33168-6213
US

V. Phone/Fax

Practice location:
  • Phone: 786-222-3633
  • Fax:
Mailing address:
  • Phone: 786-222-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberAPRN11028488
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberAPRN11028488
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN11028488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: