Provider Demographics
NPI:1215465638
Name:RIVERA MUNOZ, LAZARO JESUS
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:JESUS
Last Name:RIVERA MUNOZ
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 1:5215 W 22ND CT APT 205
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-7050
Mailing Address - Country:US
Mailing Address - Phone:305-394-7465
Mailing Address - Fax:
Practice Address - Street 1:5215 W 22ND CT APT 205
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-7050
Practice Address - Country:US
Practice Address - Phone:305-394-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician