Healthcare Provider Details

I. General information

NPI: 1265665145
Provider Name (Legal Business Name): LAZARO ROBERTO DIAZ-NUNEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2664 TAMIAMI TRL E
NAPLES FL
34112-5707
US

IV. Provider business mailing address

2664 TAMIAMI TRL E
NAPLES FL
34112-5707
US

V. Phone/Fax

Practice location:
  • Phone: 239-428-1010
  • Fax: 239-428-1010
Mailing address:
  • Phone: 239-428-1010
  • Fax: 786-294-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME108511
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME108511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: