MEDICARE: BEATRIZ DE DIEGO LAZARO

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	235Z00000X	Speech-Language Pathologist	SLP11056	AZ

General Provider Information

NPI Number	:	1871084681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRIZ DE DIEGO LAZARO

Provider Business Mailing Address
First Line	:	1216 E VISTA DEL CERRO DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-7104
Country	:	US
Telephone Number	:	602-329-7524
Fax Number	:

Provider Business Practice Location Address
First Line	:	3426 E SHEA BLVD
Second Line	:	3426 E SHEA BLVD
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3327
Country	:	US
Telephone Number	:	602-224-0598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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