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General NPI Number Information
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NPI Number | 1770291197
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Entity Type | Individual
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Provider Name | LAZARA LARITZA CABEZAS LIMA
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Gender | Female
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 816 JAMES AVE
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-3344
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Country | US
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Telephone | 786-477-3142
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Fax |
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Provider Business Mailing Address
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Address Line | 816 JAMES AVE
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-3344
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Country | US
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Telephone | 786-477-3142
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-202202
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License Number State | FL
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Legacy Identifiers
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Identifier #1
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Identifier Code | 116252900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer | Florida Medicaid Provider ID
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 116252900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer | Florida Medicaid Provider ID
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