Healthcare Provider Details

I. General information

NPI: 1144835109
Provider Name (Legal Business Name): LARITZA PEREZ DIAZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8430 SW 8TH ST APT 310
MIAMI FL
33144-4115
US

IV. Provider business mailing address

8430 SW 8TH ST APT 310
MIAMI FL
33144-4115
US

V. Phone/Fax

Practice location:
  • Phone: 832-888-8524
  • Fax:
Mailing address:
  • Phone: 832-888-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: