Healthcare Provider Details

I. General information

NPI: 1699563874
Provider Name (Legal Business Name): DARIEL LAZO OBARRIO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SW 86TH AVE
MIAMI FL
33155-3220
US

IV. Provider business mailing address

3500 SW 86TH AVE
MIAMI FL
33155-3220
US

V. Phone/Fax

Practice location:
  • Phone: 786-602-7949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11039147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: