Provider Demographics
NPI:1780914077
Name:DIAZ-LIZARDO, JOSE ALEJANDRO (MED)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:DIAZ-LIZARDO
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 MILLENIA BLVD
Mailing Address - Street 2:APT 204
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6134
Mailing Address - Country:US
Mailing Address - Phone:407-931-6583
Mailing Address - Fax:
Practice Address - Street 1:14376 COLONIAL GRAND BLVD
Practice Address - Street 2:APT. 2301
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4887
Practice Address - Country:US
Practice Address - Phone:407-931-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor