Provider Demographics
NPI:1952709883
Name:TAUZARD, LEONARDO FAVIO (TARGETED CASE MANAGE)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:FAVIO
Last Name:TAUZARD
Suffix:
Gender:M
Credentials:TARGETED CASE MANAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 SUN LAKE CIR
Mailing Address - Street 2:APT 103
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6164
Mailing Address - Country:US
Mailing Address - Phone:407-360-0989
Mailing Address - Fax:
Practice Address - Street 1:801 DOUGLAS AVE STE 208
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor