Provider Demographics
NPI:1558907832
Name:FUNEZ, HAZMIN
Entity Type:Individual
Prefix:MISS
First Name:HAZMIN
Middle Name:
Last Name:FUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TOWNSHIP LN APT A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7658
Mailing Address - Country:US
Mailing Address - Phone:337-940-2911
Mailing Address - Fax:
Practice Address - Street 1:209 CENTRE SARCELLE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-6755
Practice Address - Country:US
Practice Address - Phone:337-857-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician