Provider Demographics
NPI:1346139250
Name:OLIVA HERNANDEZ, LAZARO DANIEL
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:DANIEL
Last Name:OLIVA 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 1:13971 WINDRUSH CT APT 16
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4272
Mailing Address - Country:US
Mailing Address - Phone:954-647-6329
Mailing Address - Fax:954-647-6329
Practice Address - Street 1:13971 WINDRUSH CT APT 16
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4272
Practice Address - Country:US
Practice Address - Phone:954-647-6329
Practice Address - Fax:954-647-6329
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician