MEDICARE: KEISY DIAZ

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1003242835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISY DIAZ

Provider Business Mailing Address
First Line	:	5483 CACTUS THORN AVE APT D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-6017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5483 CACTUS THORN AVE APT D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-6017
Country	:	US
Telephone Number	:	347-549-7780
Fax Number	:

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

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/25/2013

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Directions to “ KEISY DIAZ ” Practice Location

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