Healthcare Provider Details

I. General information

NPI: 1619760246
Provider Name (Legal Business Name): AIMED DIAZ REYNALDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 SW 50TH AVE
FORT LAUDERDALE FL
33317-6202
US

IV. Provider business mailing address

2132 SW 50TH AVE
FORT LAUDERDALE FL
33317-6202
US

V. Phone/Fax

Practice location:
  • Phone: 305-307-4024
  • Fax:
Mailing address:
  • Phone: 305-307-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-425848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: