Provider Demographics
NPI:1760207682
Name:RUIZ MARRERO, LAZARO ELIXANDER
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:ELIXANDER
Last Name:RUIZ MARRERO
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 1:13365 NW 8TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2202
Mailing Address - Country:US
Mailing Address - Phone:305-741-1572
Mailing Address - Fax:
Practice Address - Street 1:8040 NW 95TH ST STE 337
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2361
Practice Address - Country:US
Practice Address - Phone:954-793-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI33562355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant