MEDICARE: SUSEJ DIAZ LEZCANO

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	106E00000X	Assistant Behavior Analyst	02515865	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457957847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSEJ DIAZ LEZCANO

Provider Business Mailing Address
First Line	:	480 NE 2ND TER UNIT 102
Second Line	:
City	:	FLORIDA CITY
State	:	FL
Zip	:	33034-7634
Country	:	US
Telephone Number	:	786-616-1089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1695 N BLUEBIRD LN
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33035-1009
Country	:	US
Telephone Number	:	786-616-1089
Fax Number	:

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

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	02/11/2026

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Directions to “ SUSEJ DIAZ LEZCANO ” Practice Location

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