Healthcare Provider Details

I. General information

NPI: 1275968513
Provider Name (Legal Business Name): DENIA LAZO SANTALLA BS / CBHCM-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST STE 203
MIAMI FL
33125-4141
US

IV. Provider business mailing address

15295 SW 107TH LN APT 1016
MIAMI FL
33196-4559
US

V. Phone/Fax

Practice location:
  • Phone: 786-220-6902
  • Fax: 866-726-0526
Mailing address:
  • Phone: 786-227-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: