Provider Demographics
NPI:1871084681
Name:DE DIEGO LAZARO, BEATRIZ
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:DE DIEGO LAZARO
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 1:1216 E VISTA DEL CERRO DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7104
Mailing Address - Country:US
Mailing Address - Phone:602-329-7524
Mailing Address - Fax:
Practice Address - Street 1:3426 E SHEA BLVD
Practice Address - Street 2:3426 E SHEA BLVD
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3327
Practice Address - Country:US
Practice Address - Phone:602-224-0598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist