Healthcare Provider Details

I. General information

NPI: 1871701334
Provider Name (Legal Business Name): MARIOARA LAZAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

2705 S PARKVIEW DR
HALLANDALE BEACH FL
33009-2920
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-6994
  • Fax: 954-965-6468
Mailing address:
  • Phone: 954-478-9910
  • Fax: 954-454-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME85656
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME85656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: