Healthcare Provider Details

I. General information

NPI: 1043749823
Provider Name (Legal Business Name): BREYDIK DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 04/24/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 SUNSET DR STE 101
MIAMI FL
33173-3259
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-7790
  • Fax: 954-577-7780
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: