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General NPI Number Information
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NPI Number | 1780914077
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Entity Type | Individual
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Provider Name | JOSE ALEJANDRO DIAZ-LIZARDO M.ED.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 14376 COLONIAL GRAND BLVD APT. 2301
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City | ORLANDO
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State | FL
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Zip | 32837-4887
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Country | US
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Telephone | 407-931-6583
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Fax |
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Provider Business Mailing Address
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Address Line | 5221 MILLENIA BLVD APT 204
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City | ORLANDO
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State | FL
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Zip | 32839-6134
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Country | US
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Telephone | 407-931-6583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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