MEDICARE: DR. ROYCE JALAZO, P.A.

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
1	103TC0700X	Clinical Psychologist	PY7671	FL

General Provider Information

NPI Number	:	1639496664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ROYCE JALAZO, P.A.

Provider Business Mailing Address
First Line	:	1975 E SUNRISE BLVD
Second Line	:	SUITE 532
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-1433
Country	:	US
Telephone Number	:	954-232-7092
Fax Number	:	954-208-3400

Provider Business Practice Location Address
First Line	:	1975 E SUNRISE BLVD
Second Line	:	SUITE 532
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-1433
Country	:	US
Telephone Number	:	954-232-7092
Fax Number	:	954-208-3400

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROYCE N JALAZO
Credential	:	PSY.D.
Telephone Number	:	954-232-7092

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	11/18/2016

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