MEDICARE: BLANCA DIAZ BCBA

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	1-20-41130	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	:	1477926426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA DIAZ BCBA

Provider Business Mailing Address
First Line	:	1870 DELAWARE PKWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1114
Country	:	US
Telephone Number	:	786-261-7144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 DELAWARE PKWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-1114
Country	:	US
Telephone Number	:	786-261-7144
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	03/28/2022

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