Healthcare Provider Details

I. General information

NPI: 1083546527
Provider Name (Legal Business Name): DIEGO ALONSO CHAVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S LAKE DESTINY RD STE 350
MAITLAND FL
32751-7222
US

IV. Provider business mailing address

12153 KINGS KNIGHT WAY
ORLANDO FL
32817-8445
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-6555
  • Fax:
Mailing address:
  • Phone: 407-647-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: