Provider Demographics
NPI:1215641295
Name:DR LAUZURIQUE PHD PA
Entity type:Organization
Organization Name:DR LAUZURIQUE PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUZURIQUE GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-528-5560
Mailing Address - Street 1:209 COBALT DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3006
Mailing Address - Country:US
Mailing Address - Phone:787-528-5560
Mailing Address - Fax:
Practice Address - Street 1:209 COBALT DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3006
Practice Address - Country:US
Practice Address - Phone:787-528-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty