Provider Demographics
NPI:1457151169
Name:LOPEZ HERNANDEZ, LAZARO RICARDO
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:RICARDO
Last Name:LOPEZ HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12792 SW 45TH DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6046
Mailing Address - Country:US
Mailing Address - Phone:786-970-6278
Mailing Address - Fax:
Practice Address - Street 1:1970 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2682
Practice Address - Country:US
Practice Address - Phone:786-846-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-418630106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician