Provider Demographics
NPI:1639560667
Name:DIAZ, LAZARO (BS)
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13665 SW 99TH ST APT 1307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2807
Mailing Address - Country:US
Mailing Address - Phone:786-253-1407
Mailing Address - Fax:305-230-7601
Practice Address - Street 1:445 NW 4TH ST
Practice Address - Street 2:APT 1307
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1688
Practice Address - Country:US
Practice Address - Phone:786-253-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0276689292Medicaid