Provider Demographics
NPI:1285359091
Name:LAREZ, NATHACHA DEL VALLE
Entity type:Individual
Prefix:
First Name:NATHACHA
Middle Name:DEL VALLE
Last Name:LAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-7017
Mailing Address - Country:US
Mailing Address - Phone:786-914-8008
Mailing Address - Fax:
Practice Address - Street 1:1554 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-7017
Practice Address - Country:US
Practice Address - Phone:786-914-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician