Healthcare Provider Details

I. General information

NPI: 1528844651
Provider Name (Legal Business Name): RAMON YANIEL GATTORNO DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST STE 332
HIALEAH FL
33012-3489
US

IV. Provider business mailing address

8391 NW 142ND ST
MIAMI LAKES FL
33016-5728
US

V. Phone/Fax

Practice location:
  • Phone: 786-789-5305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24915
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: