Healthcare Provider Details

I. General information

NPI: 1821622333
Provider Name (Legal Business Name): ISMERY DIAZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 TAMPA RD
OLDSMAR FL
34677-3201
US

IV. Provider business mailing address

1302 IVYWOOD DR
BRANDON FL
33510-2254
US

V. Phone/Fax

Practice location:
  • Phone: 813-305-7037
  • Fax:
Mailing address:
  • Phone: 863-808-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1050546000
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12044
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: