Provider Demographics
NPI:1790432771
Name:ARMENTEROS LASTRA, PABLO CARIDAD
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:CARIDAD
Last Name:ARMENTEROS LASTRA
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 1:2882 W 72ND TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5389
Mailing Address - Country:US
Mailing Address - Phone:305-414-3922
Mailing Address - Fax:
Practice Address - Street 1:3730 SW 123RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3046
Practice Address - Country:US
Practice Address - Phone:305-414-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-199631106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician