Provider Demographics
NPI:1154708584
Name:LAZU, CARLOS
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:LAZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7252
Mailing Address - Country:US
Mailing Address - Phone:239-540-8011
Mailing Address - Fax:239-540-9011
Practice Address - Street 1:2804 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7252
Practice Address - Country:US
Practice Address - Phone:239-540-8011
Practice Address - Fax:239-540-9011
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)