Healthcare Provider Details

I. General information

NPI: 1770220980
Provider Name (Legal Business Name): MIDIALYS DIAZ QUINTERO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 NW 174TH TER APT D103
HIALEAH FL
33015-1141
US

IV. Provider business mailing address

7369 NW 174TH TER APT D103
HIALEAH FL
33015-1141
US

V. Phone/Fax

Practice location:
  • Phone: 786-690-1299
  • Fax:
Mailing address:
  • Phone: 786-690-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-2829612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: