MEDICARE: ALLISON 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	106S00000X	Behavior Technician

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	:	1477131951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON DIAZ

Provider Business Mailing Address
First Line	:	8103 SANDYWOOD DR
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-7240
Country	:	US
Telephone Number	:	954-214-8029
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 S. HIAWASSEE RD SUITE 203 ROOM 1229
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835
Country	:	US
Telephone Number	:	219-724-0393
Fax Number	:

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

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	06/10/2022

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