Provider Demographics
NPI:1881930311
Name:HAFEZ-LUX, RANDA (ITDS)
Entity type:Individual
Prefix:MRS
First Name:RANDA
Middle Name:
Last Name:HAFEZ-LUX
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 61ST ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7036
Mailing Address - Country:US
Mailing Address - Phone:727-741-3405
Mailing Address - Fax:727-213-6246
Practice Address - Street 1:8422 SUN DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3339
Practice Address - Country:US
Practice Address - Phone:727-741-3405
Practice Address - Fax:727-213-6246
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist