MEDICARE: RAMON YANIEL GATTORNO 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
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1528844651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMON YANIEL GATTORNO DIAZ

Provider Business Mailing Address
First Line	:	8391 NW 142ND ST
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 W 49TH ST STE 332
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3489
Country	:	US
Telephone Number	:	786-789-5305
Fax Number	:

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

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	08/13/2025

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