Basic Information
| Provider Information | |||||||||
| NPI: | 1275059305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELGADO HEVIA | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | LAZARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12370 SW 212TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331775901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057266124 | ||||||||
| FaxNumber: | 7862064702 | ||||||||
| Practice Location | |||||||||
| Address1: | 14225 SW 156TH TER | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331771037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057266124 | ||||||||
| FaxNumber: | 7862064702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.