Provider Demographics
NPI:1093986416
Name:JALAZO, ROYCE N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:N
Last Name:JALAZO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 E SUNRISE BLVD
Mailing Address - Street 2:SUITE 532
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1433
Mailing Address - Country:US
Mailing Address - Phone:954-232-7092
Mailing Address - Fax:954-208-3400
Practice Address - Street 1:1975 E SUNRISE BLVD
Practice Address - Street 2:SUITE 532
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1433
Practice Address - Country:US
Practice Address - Phone:954-232-7092
Practice Address - Fax:954-208-3400
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical