Healthcare Provider Details

I. General information

NPI: 1689555054
Provider Name (Legal Business Name): PAOLA VILCHEZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10355 STAR FLOWER LN
RIVERVIEW FL
33578-9462
US

IV. Provider business mailing address

10355 STAR FLOWER LN
RIVERVIEW FL
33578-9462
US

V. Phone/Fax

Practice location:
  • Phone: 404-528-6523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-490654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: