Healthcare Provider Details

I. General information

NPI: 1003424185
Provider Name (Legal Business Name): MARILU LEZCANO ALFONSO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 NW 27TH AVE APT 201
MIAMI FL
33147-5519
US

IV. Provider business mailing address

7735 NW 27TH AVE APT 201
MIAMI FL
33147-5519
US

V. Phone/Fax

Practice location:
  • Phone: 786-622-7155
  • Fax:
Mailing address:
  • Phone: 786-622-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-122-174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: