Provider Demographics
NPI:1265665145
Name:DIAZ-NUNEZ, LAZARO ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:ROBERTO
Last Name:DIAZ-NUNEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5707
Mailing Address - Country:US
Mailing Address - Phone:239-428-1010
Mailing Address - Fax:786-294-0124
Practice Address - Street 1:2664 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5707
Practice Address - Country:US
Practice Address - Phone:239-428-1010
Practice Address - Fax:239-428-1010
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108511207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1265665145Medicaid