Provider Demographics
NPI:1417106261
Name:GARCIA, LAZARO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAZARO
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7805 CORAL WAY
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6539
Mailing Address - Country:US
Mailing Address - Phone:305-264-9044
Mailing Address - Fax:305-264-8971
Practice Address - Street 1:7805 CORAL WAY
Practice Address - Street 2:SUITE 118
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6539
Practice Address - Country:US
Practice Address - Phone:305-264-9044
Practice Address - Fax:305-264-8971
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3472103TB0200X, 103TC0700X, 103TF0200X, 103TM1800X
NY007961-1103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75510Medicare PIN