MEDICARE: DIANELIS MORALES

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	BACB560237	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	:	1821722687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANELIS MORALES

Provider Business Mailing Address
First Line	:	7722 W 34TH LN UNIT 202
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5035
Country	:	US
Telephone Number	:	786-879-4857
Fax Number	:

Provider Business Practice Location Address
First Line	:	7722 W 34TH LN UNIT 202
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-5035
Country	:	US
Telephone Number	:	786-879-4857
Fax Number	:

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

Provider Enumeration Date	:	07/15/2022
Last Update Date	:	07/15/2022

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Directions to “ DIANELIS MORALES ” Practice Location

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