Healthcare Provider Details

I. General information

NPI: 1124369020
Provider Name (Legal Business Name): LAZARO DIAZ-NUNEZ, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 PALM AVE
HIALEAH FL
33012-5427
US

IV. Provider business mailing address

7200 CORPORATE CENTER DR 600
MIAMI FL
33126-1200
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-1000
  • Fax: 305-558-1212
Mailing address:
  • Phone: 305-500-2000
  • Fax: 305-500-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberME108511
License Number StateFL

VIII. Authorized Official

Name: HOLLY LOPEZ
Title or Position: VP SUPPORT SERVICES
Credential:
Phone: 305-500-2108