Healthcare Provider Details

I. General information

NPI: 1851832935
Provider Name (Legal Business Name): GUILLERMO A DIAZ CABRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 MIRAMAR PKWY
MIRAMAR FL
33025-2852
US

IV. Provider business mailing address

8424 MIRAMAR PKWY
MIRAMAR FL
33025-2852
US

V. Phone/Fax

Practice location:
  • Phone: 786-720-5170
  • Fax:
Mailing address:
  • Phone: 786-720-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-117285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: