Provider Demographics
NPI:1093404030
Name:LAHERA ANDRE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LAHERA ANDRE
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 1:10200 NW 25TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5919
Mailing Address - Country:US
Mailing Address - Phone:305-908-2999
Mailing Address - Fax:305-351-1798
Practice Address - Street 1:10200 NW 25TH ST STE 114
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5919
Practice Address - Country:US
Practice Address - Phone:305-908-2999
Practice Address - Fax:305-351-1798
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-265166106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician