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NPI Code Detail

MEDICARE: ODALYS LAZO DIAZ

MEDICARE: ODALYS LAZO DIAZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse354982NY

General Provider Information

NPI Number : 1598622219
Entity Type Code : Individual
Provider Name (Legal Business Name) : ODALYS LAZO DIAZ
Provider Business Mailing Address
First Line : 29B PINEVILLE RD
Second Line :
City : CENTRAL ISLIP
State : NY
Zip : 11722-2310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4238 MERRICK RD
Second Line :
City : MASSAPEQUA
State : NY
Zip : 11758-6016
Country : US
Telephone Number : 631-690-5155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “ ODALYS LAZO DIAZ ” Practice Location

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