Provider Demographics
NPI:1265141618
Name:HERNANDEZ LAUZARDO, ANA NIURKA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:NIURKA
Last Name:HERNANDEZ LAUZARDO
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 1:15790 SW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5232
Mailing Address - Country:US
Mailing Address - Phone:786-318-9489
Mailing Address - Fax:
Practice Address - Street 1:15790 SW 84TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5232
Practice Address - Country:US
Practice Address - Phone:786-318-9489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-23-69243103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician