Healthcare Provider Details

I. General information

NPI: 1922672492
Provider Name (Legal Business Name): DIANA MEJIA PEREZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 02/06/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 VILLAGE BLVD
WEST PALM BEACH FL
33409-1803
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 561-657-5768
  • Fax:
Mailing address:
  • Phone: 561-657-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCBHCM103331
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-407322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: