Provider Demographics
NPI:1619783180
Name:LAZO DIAZ, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:LAZO DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 MAGNOLIA PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8669
Mailing Address - Country:US
Mailing Address - Phone:786-675-0903
Mailing Address - Fax:
Practice Address - Street 1:5911 MAGNOLIA PARK BLVD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-8669
Practice Address - Country:US
Practice Address - Phone:786-675-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist