MEDICARE: LAZARA GONZALEZ

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

General Provider Information

NPI Number	:	1720505183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAZARA GONZALEZ

Provider Business Mailing Address
First Line	:	2313 W 60TH ST APT 206
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4501
Country	:	US
Telephone Number	:	786-955-3747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 W 60TH ST APT 206
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-4501
Country	:	US
Telephone Number	:	786-955-3747
Fax Number	:

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

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	07/21/2022

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Directions to “ LAZARA GONZALEZ ” Practice Location

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