Healthcare Provider Details

I. General information

NPI: 1295281186
Provider Name (Legal Business Name): MRS. MINERVA ARACELY LAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11252 NW 3RD TER
MIAMI FL
33172-3529
US

IV. Provider business mailing address

11252 NW 3RD TER
MIAMI FL
33172-3529
US

V. Phone/Fax

Practice location:
  • Phone: 786-417-9936
  • Fax:
Mailing address:
  • Phone: 786-417-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: