Healthcare Provider Details

I. General information

NPI: 1558006775
Provider Name (Legal Business Name): DANIELA HURTADO DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15771 SW 137TH AVE APT 203
MIAMI FL
33177-8131
US

IV. Provider business mailing address

15771 SW 137TH AVE APT 203
MIAMI FL
33177-8131
US

V. Phone/Fax

Practice location:
  • Phone: 786-808-9920
  • Fax:
Mailing address:
  • Phone: 786-808-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-198728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: