Healthcare Provider Details

I. General information

NPI: 1255504056
Provider Name (Legal Business Name): LYDIA M LAZARO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 URB SERENNA LOS PRADOS
CAGUAS PR
00727-3318
US

IV. Provider business mailing address

PO BOX 8129 LOS PRADOS
BAYAMON PR
00960-8129
US

V. Phone/Fax

Practice location:
  • Phone: 787-994-6746
  • Fax:
Mailing address:
  • Phone: 787-994-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2995
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: