Provider Demographics
NPI:1811613433
Name:OPADA, DARIUS II LAZARO
Entity type:Individual
Prefix:MR
First Name:DARIUS II
Middle Name:LAZARO
Last Name:OPADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 FOOTHILLS PKWY NE # 417
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3840
Mailing Address - Country:US
Mailing Address - Phone:615-594-6940
Mailing Address - Fax:
Practice Address - Street 1:45 LUDLOW ST STE 402
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1949
Practice Address - Country:US
Practice Address - Phone:347-667-7924
Practice Address - Fax:332-262-2396
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN291021163WP0808X
NY406781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health