Healthcare Provider Details

I. General information

NPI: 1992618680
Provider Name (Legal Business Name): BEYOND POTENTIAL BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36739 COUNTY ROAD 52 STE 204
DADE CITY FL
33525-5101
US

IV. Provider business mailing address

36739 COUNTY ROAD 52 STE 204
DADE CITY FL
33525-5101
US

V. Phone/Fax

Practice location:
  • Phone: 813-336-8850
  • Fax: 813-336-8870
Mailing address:
  • Phone: 813-336-8850
  • Fax: 813-336-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: GILBERTO DIAZ MIRA
Title or Position: PRESIDENT
Credential:
Phone: 479-420-9849