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NPI Code Detail

MEDICARE: MICHELL DIAZ PEREA

MEDICARE: MICHELL DIAZ PEREA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1396543955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELL DIAZ PEREA
Provider Business Mailing Address
First Line : 3621 MARION LN
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-7579
Country : US
Telephone Number : 50-592-9620
Fax Number :
Provider Business Practice Location Address
First Line : 1715 149TH ST FL 2
Second Line :
City : WHITESTONE
State : NY
Zip : 11357-2529
Country : US
Telephone Number : 516-217-6949
Fax Number : 516-726-9924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2025
Last Update Date : 03/07/2025

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Directions to “ MICHELL DIAZ PEREA ” Practice Location

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