Provider Demographics
NPI:1376382812
Name:LASCANO, CHRISTIAN JAVIER
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JAVIER
Last Name:LASCANO
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 1:13445 SW 153RD TER APT 1803
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1185
Mailing Address - Country:US
Mailing Address - Phone:305-726-3968
Mailing Address - Fax:
Practice Address - Street 1:8500 SW 8TH ST STE 258
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4000
Practice Address - Country:US
Practice Address - Phone:305-810-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-326082106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician