Individual
ALYSE LAZARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16414 LAKE CHURCH DR, ODESSA, FL 33556-2637
(813) 926-5454
Mailing address
5703 SW 108TH ST, OCALA, FL 34476-9147
(352) 502-6495
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
FL
Other
Enumeration date
05/20/2018
Last updated
05/20/2018
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