Provider Demographics
NPI:1356882328
Name:OJITO LEZCANO, MIDALYS
Entity type:Individual
Prefix:
First Name:MIDALYS
Middle Name:
Last Name:OJITO LEZCANO
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 1:7016 PINEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4518
Mailing Address - Country:US
Mailing Address - Phone:702-494-9375
Mailing Address - Fax:
Practice Address - Street 1:7016 PINEBROOK CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4518
Practice Address - Country:US
Practice Address - Phone:702-494-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician