Healthcare Provider Details

I. General information

NPI: 1902737182
Provider Name (Legal Business Name): AMANDA RUEDA DIAZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 SW 39TH ST
MIRAMAR FL
33025-7353
US

IV. Provider business mailing address

3780 NW 193RD ST
MIAMI GARDENS FL
33055-1927
US

V. Phone/Fax

Practice location:
  • Phone: 786-523-9153
  • Fax:
Mailing address:
  • Phone: 786-642-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: