Provider Demographics
NPI:1417714635
Name:CRESPO PERMUY, LAZARO DAVID
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:DAVID
Last Name:CRESPO PERMUY
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 1:933 SW 153RD PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2727
Mailing Address - Country:US
Mailing Address - Phone:786-241-1821
Mailing Address - Fax:
Practice Address - Street 1:933 SW 153RD PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2727
Practice Address - Country:US
Practice Address - Phone:786-241-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician