Provider Demographics
NPI:1497431423
Name:MOLINA RODRIGUEZ, LAZARO
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:MOLINA RODRIGUEZ
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 1:6408 N ARMENIA AVE STE E-1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5770
Mailing Address - Country:US
Mailing Address - Phone:754-234-4331
Mailing Address - Fax:
Practice Address - Street 1:6408 N ARMENIA AVE STE E-1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5770
Practice Address - Country:US
Practice Address - Phone:754-234-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker