Provider Demographics
NPI:1508755828
Name:HERNANDEZ LANDETA, LUZ ANAYELIZ
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ANAYELIZ
Last Name:HERNANDEZ LANDETA
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 1:15 SOUTHERN CROSS CIR APT 207
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6748
Mailing Address - Country:US
Mailing Address - Phone:786-830-6561
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTHERN CROSS CIR APT 207
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6748
Practice Address - Country:US
Practice Address - Phone:786-830-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician