Provider Demographics
NPI:1255112512
Name:AJA, LAIZ LAURA
Entity type:Individual
Prefix:
First Name:LAIZ
Middle Name:LAURA
Last Name:AJA
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 1:9961 NW 9TH STREET CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5150
Mailing Address - Country:US
Mailing Address - Phone:305-397-5345
Mailing Address - Fax:
Practice Address - Street 1:9961 NW 9TH STREET CIR APT 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5150
Practice Address - Country:US
Practice Address - Phone:305-397-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician