Healthcare Provider Details

I. General information

NPI: 1548199060
Provider Name (Legal Business Name): DIAMOND BLANDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2029 NW 46TH AVE APT E106
LAUDERHILL FL
33313-4241
US

IV. Provider business mailing address

2029 NW 46TH AVE APT E106
LAUDERHILL FL
33313-4241
US

V. Phone/Fax

Practice location:
  • Phone: 954-667-4265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-536983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: