Provider Demographics
NPI:1164114484
Name:CARRILLO-PEREZ, LAZARO J
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:J
Last Name:CARRILLO-PEREZ
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 1:110 BRITTANY CT
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-2871
Mailing Address - Country:US
Mailing Address - Phone:786-537-5663
Mailing Address - Fax:
Practice Address - Street 1:110 BRITTANY CT
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2871
Practice Address - Country:US
Practice Address - Phone:786-537-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician