Healthcare Provider Details

I. General information

NPI: 1669214904
Provider Name (Legal Business Name): ANA MASSIEL DIAZ BERMUDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 PIONEER RD
WEST PALM BEACH FL
33411-4623
US

IV. Provider business mailing address

8421 PIONEER RD
WEST PALM BEACH FL
33411-4623
US

V. Phone/Fax

Practice location:
  • Phone: 786-624-1947
  • Fax:
Mailing address:
  • Phone: 786-624-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: