Healthcare Provider Details

I. General information

NPI: 1558805069
Provider Name (Legal Business Name): DANIEL DIAZ PANDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20541 SW 79TH CT
CUTLER BAY FL
33189-2184
US

IV. Provider business mailing address

20541 SW 79TH CT
CUTLER BAY FL
33189-2184
US

V. Phone/Fax

Practice location:
  • Phone: 786-991-3706
  • Fax: 786-206-7074
Mailing address:
  • Phone: 786-991-3706
  • Fax: 786-206-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-90845
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBCABA-0-21-13217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: