MEDICARE: DOUGLAS LAZARO GUILLEN GARCIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-397510	FL

General Provider Information

NPI Number	:	1093527160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS LAZARO GUILLEN GARCIA

Provider Business Mailing Address
First Line	:	3003 36TH ST SW
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33976-4671
Country	:	US
Telephone Number	:	239-248-4812
Fax Number	:

Provider Business Practice Location Address
First Line	:	12651 MCGREGOR BLVD STE 501
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4496
Country	:	US
Telephone Number	:	239-691-6482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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Directions to “ DOUGLAS LAZARO GUILLEN GARCIA ” Practice Location

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