Provider Demographics
NPI:1942053061
Name:ALONSO TORRES, LAZARO MANUEL
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:MANUEL
Last Name:ALONSO TORRES
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 1:14850 SW 153RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-5553
Mailing Address - Country:US
Mailing Address - Phone:786-608-3857
Mailing Address - Fax:
Practice Address - Street 1:14850 SW 153RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-5553
Practice Address - Country:US
Practice Address - Phone:786-608-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-326943106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician