Provider Demographics
NPI:1871061283
Name:TERESA-CALLEJA, LAZARO JR (NP)
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:TERESA-CALLEJA
Suffix:JR
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7959 NW 51ST CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5037
Mailing Address - Country:US
Mailing Address - Phone:786-613-9469
Mailing Address - Fax:
Practice Address - Street 1:7959 NW 51ST CT
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5037
Practice Address - Country:US
Practice Address - Phone:786-613-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9413193363LF0000X
FL12579233103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily