Provider Demographics
NPI:1033993423
Name:HERNANDEZ, WILLIAM LAZARO
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAZARO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N 68TH TER
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7538
Mailing Address - Country:US
Mailing Address - Phone:754-275-6882
Mailing Address - Fax:
Practice Address - Street 1:830 N 68TH TER
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7538
Practice Address - Country:US
Practice Address - Phone:754-275-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health