Provider Demographics
NPI:1679167886
Name:FERNANDEZ, LAIZA M
Entity Type:Individual
Prefix:
First Name:LAIZA
Middle Name:M
Last Name:FERNANDEZ
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 1:19620 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8556
Mailing Address - Country:US
Mailing Address - Phone:305-528-4869
Mailing Address - Fax:
Practice Address - Street 1:93911 OVERSEAS HWY STE 8
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-3025
Practice Address - Country:US
Practice Address - Phone:786-419-9609
Practice Address - Fax:305-418-7419
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician