Organization
IMPOWER
Active
Organization
IMPOWER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYDIA OYOLA-DIAZ M.ED (CLINICIAN)
(860) 083-7230
Entity
Organization
Contact information
Practice address
587 E STATE ROAD 434, SUITE1021, LONGWOOD, FL 32750-5201
(407) 331-8002
(407) 331-8659
Mailing address
1065 S KIRKMAN RD, 132, ORLANDO, FL 32811-3214
(860) 983-7230
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3120806
—
FL
Enumeration date
09/19/2014
Last updated
09/19/2014
Update your record
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