Healthcare Provider Details

I. General information

NPI: 1811688864
Provider Name (Legal Business Name): ANNA LILY PRENDES DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 NE 9TH AVE APT 201
BOYNTON BEACH FL
33435-3106
US

IV. Provider business mailing address

117 NE 9TH AVE APT 201
BOYNTON BEACH FL
33435-3106
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-5490
  • Fax:
Mailing address:
  • Phone: 786-663-5490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2829891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: