MEDICARE: LYDIA OYOLA-DIAZ M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	101YMO800X	FL

General Provider Information

NPI Number	:	1033512629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA OYOLA-DIAZ M.ED

Provider Business Mailing Address
First Line	:	587 E STATE ROAD 434 UNIT 1021
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5284
Country	:	US
Telephone Number	:	407-331-8002
Fax Number	:	407-331-8659

Provider Business Practice Location Address
First Line	:	587 E STATE ROAD 434 UNIT 1021
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5284
Country	:	US
Telephone Number	:	407-331-8002
Fax Number	:	407-331-8659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2014
Last Update Date	:	09/26/2014

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