Healthcare Provider Details

I. General information

NPI: 1386201796
Provider Name (Legal Business Name): DIANETSY CABRERA SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 234
DORAL FL
33122-1086
US

IV. Provider business mailing address

1900 N 68TH AVE
HOLLYWOOD FL
33024-3913
US

V. Phone/Fax

Practice location:
  • Phone: 305-733-7062
  • Fax:
Mailing address:
  • Phone: 786-709-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: