MEDICARE: ZAHELYS ROSETE DIAZ RBT

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	106S00000X	Behavior Technician	RBT-24-323748	FL

General Provider Information

NPI Number	:	1447016696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAHELYS ROSETE DIAZ RBT

Provider Business Mailing Address
First Line	:	1561 E 6TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-3205
Country	:	US
Telephone Number	:	786-917-0491
Fax Number	:

Provider Business Practice Location Address
First Line	:	11285 SW 211TH ST STE 207
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33189-2213
Country	:	US
Telephone Number	:	786-633-2937
Fax Number	:

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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