Provider Demographics
NPI:1922470467
Name:LACHAGA, JULIO CESAR JR
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:CESAR
Last Name:LACHAGA
Suffix:JR
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 1:2710 FORESTDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9316
Mailing Address - Country:US
Mailing Address - Phone:801-487-0499
Mailing Address - Fax:
Practice Address - Street 1:10502 SATELLITE BLVD STE D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8479
Practice Address - Country:US
Practice Address - Phone:801-413-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3984106H00000X
UT10111946-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist