MEDICARE: ITAYNA GORDO LAUZURIQUE

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-25-496572	FL

General Provider Information

NPI Number	:	1104753839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITAYNA GORDO LAUZURIQUE

Provider Business Mailing Address
First Line	:	2008 NW 7TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-7128
Country	:	US
Telephone Number	:	239-321-4696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 SE 46TH LN STE 2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8647
Country	:	US
Telephone Number	:	239-257-1572
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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