Provider Demographics
NPI:1477215671
Name:LAZO VAZQUEZ, ADRIA MARIA (RBT)
Entity Type:Individual
Prefix:
First Name:ADRIA
Middle Name:MARIA
Last Name:LAZO VAZQUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-1066
Mailing Address - Country:US
Mailing Address - Phone:561-932-9991
Mailing Address - Fax:
Practice Address - Street 1:177 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-1066
Practice Address - Country:US
Practice Address - Phone:561-932-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-186383106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-186383OtherBACB