Healthcare Provider Details

I. General information

NPI: 1740051135
Provider Name (Legal Business Name): MRS. DIANET FRAGOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 NW 79TH AVE
DORAL FL
33122-1033
US

IV. Provider business mailing address

12348 NW 98TH PL
HIALEAH FL
33018-2960
US

V. Phone/Fax

Practice location:
  • Phone: 305-597-3861
  • Fax:
Mailing address:
  • Phone: 786-901-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: