Healthcare Provider Details

I. General information

NPI: 1265344022
Provider Name (Legal Business Name): ABIGAIL DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 136TH AVE
DAVIE FL
33325-3153
US

IV. Provider business mailing address

9130 NW 162ND TER
MIAMI LAKES FL
33018-6302
US

V. Phone/Fax

Practice location:
  • Phone: 954-410-4106
  • Fax:
Mailing address:
  • Phone: 786-870-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: