Provider Demographics
NPI:1649065863
Name:LAUZAN RIVERO, MAILEIDYS
Entity type:Individual
Prefix:MRS
First Name:MAILEIDYS
Middle Name:
Last Name:LAUZAN RIVERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 NE 8TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-4460
Mailing Address - Country:US
Mailing Address - Phone:786-593-4340
Mailing Address - Fax:
Practice Address - Street 1:1475 COLLINGSWOOD BLVD UNIT G
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1150
Practice Address - Country:US
Practice Address - Phone:941-716-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty