Healthcare Provider Details

I. General information

NPI: 1255243879
Provider Name (Legal Business Name): CAMILA FERNANDA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10795 NW 50TH ST DORAL APT 308
MIAMI FL
33178
US

IV. Provider business mailing address

10795 NW 50TH ST DORAL APT 308
MIAMI FL
33178
US

V. Phone/Fax

Practice location:
  • Phone: 786-630-6609
  • Fax:
Mailing address:
  • Phone: 786-630-6609
  • 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: