Provider Demographics
NPI:1033512629
Name:OYOLA-DIAZ, LYDIA (MED)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:OYOLA-DIAZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 E STATE ROAD 434 UNIT 1021
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5284
Mailing Address - Country:US
Mailing Address - Phone:407-331-8002
Mailing Address - Fax:407-331-8659
Practice Address - Street 1:587 E STATE ROAD 434 UNIT 1021
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5284
Practice Address - Country:US
Practice Address - Phone:407-331-8002
Practice Address - Fax:407-331-8659
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YMO800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health