Provider Demographics
NPI:1013542661
Name:LAZO, DARIAN A
Entity Type:Individual
Prefix:
First Name:DARIAN
Middle Name:A
Last Name:LAZO
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 1:17710 SW 176TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1694
Mailing Address - Country:US
Mailing Address - Phone:305-244-9507
Mailing Address - Fax:
Practice Address - Street 1:730 SW 4TH STREET
Practice Address - Street 2:UNIT 6
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991
Practice Address - Country:US
Practice Address - Phone:305-244-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician