Provider Demographics
NPI:1275236978
Name:LAUZURIQUE HERNANDEZ, ANYCHEL (DH23345)
Entity Type:Individual
Prefix:
First Name:ANYCHEL
Middle Name:
Last Name:LAUZURIQUE HERNANDEZ
Suffix:
Gender:F
Credentials:DH23345
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 W DR MARTIN LUTHER KING JR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6219
Mailing Address - Country:US
Mailing Address - Phone:949-556-1669
Mailing Address - Fax:
Practice Address - Street 1:3109 W DR MARTIN LUTHER KING JR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6219
Practice Address - Country:US
Practice Address - Phone:949-556-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH23345124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist