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General NPI Number Information
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NPI Number | 1972457158
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Entity Type | Individual
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Provider Name | CARLOS M DIAZ-LAZARO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 4651 SALISBURY RD STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6187
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Country | US
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Telephone | 727-777-6630
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Fax |
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Provider Business Mailing Address
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Address Line | 4651 SALISBURY RD STE 400
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6187
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Country | US
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Telephone |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY11782
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License Number State | FL
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