Provider Demographics
NPI:1487466678
Name:RODRIGUEZ MARTINEZ, LAZARO JAVIER
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:JAVIER
Last Name:RODRIGUEZ MARTINEZ
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 1:1911 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-4209
Mailing Address - Country:US
Mailing Address - Phone:786-719-0321
Mailing Address - Fax:
Practice Address - Street 1:1911 GATEWOOD DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-4209
Practice Address - Country:US
Practice Address - Phone:786-719-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-407072106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician