Provider Demographics
NPI:1053065961
Name:CESAR-HEREAUX, LOURDES-MIA M
Entity Type:Individual
Prefix:
First Name:LOURDES-MIA
Middle Name:M
Last Name:CESAR-HEREAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10306 NW 80TH DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1154
Mailing Address - Country:US
Mailing Address - Phone:305-775-8128
Mailing Address - Fax:
Practice Address - Street 1:10306 NW 80TH DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1154
Practice Address - Country:US
Practice Address - Phone:305-775-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical