Provider Demographics
NPI:1386150779
Name:QUINONES GARCIA, LAZARO M
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:M
Last Name:QUINONES GARCIA
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 1:9362 W 33RD LN UNIT 9362
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2068
Mailing Address - Country:US
Mailing Address - Phone:979-330-8657
Mailing Address - Fax:
Practice Address - Street 1:9362 W 33RD LN UNIT 9362
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-2068
Practice Address - Country:US
Practice Address - Phone:979-330-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-72679106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023346700Medicaid