Healthcare Provider Details

I. General information

NPI: 1093605057
Provider Name (Legal Business Name): MARITZA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 ARBORVISTA DR
SAINT CLOUD FL
34771-9312
US

IV. Provider business mailing address

5604 ARBORVISTA DR
SAINT CLOUD FL
34771-9312
US

V. Phone/Fax

Practice location:
  • Phone: 786-930-0001
  • Fax:
Mailing address:
  • Phone: 786-930-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-448856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: