Healthcare Provider Details

I. General information

NPI: 1013542661
Provider Name (Legal Business Name): DARIAN A LAZO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SW 4TH STREET UNIT 6
CAPE CORAL FL
33991
US

IV. Provider business mailing address

17710 SW 176TH ST
MIAMI FL
33187-1694
US

V. Phone/Fax

Practice location:
  • Phone: 305-244-9507
  • Fax:
Mailing address:
  • Phone: 305-244-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: