Healthcare Provider Details

I. General information

NPI: 1306405683
Provider Name (Legal Business Name): DIANA CASSOLA ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11027 SW 148TH CT
MIAMI FL
33196-3302
US

IV. Provider business mailing address

15350 SW 76TH TER APT 206
MIAMI FL
33193-1759
US

V. Phone/Fax

Practice location:
  • Phone: 786-907-2615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-86198
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: