Healthcare Provider Details

I. General information

NPI: 1598687287
Provider Name (Legal Business Name): AIDA LAZO PALENZUELA APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6462 SW 129TH AVE
MIAMI FL
33183-1372
US

IV. Provider business mailing address

6462 SW 129TH AVE
MIAMI FL
33183-1372
US

V. Phone/Fax

Practice location:
  • Phone: 786-399-1767
  • Fax:
Mailing address:
  • Phone: 786-399-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11049533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: