Provider Demographics
NPI:1104634203
Name:LLANES GARCIA, LAZARA ISEL
Entity type:Individual
Prefix:
First Name:LAZARA
Middle Name:ISEL
Last Name:LLANES GARCIA
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 1:19060 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2755
Mailing Address - Country:US
Mailing Address - Phone:305-589-4739
Mailing Address - Fax:
Practice Address - Street 1:10700 CARIBBEAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1224
Practice Address - Country:US
Practice Address - Phone:305-589-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty