Healthcare Provider Details

I. General information

NPI: 1295318244
Provider Name (Legal Business Name): NOELIA M DIAZ BLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 WINTERBERRY LN
WESTON FL
33327-2335
US

IV. Provider business mailing address

1689 WINTERBERRY LN
WESTON FL
33327-2335
US

V. Phone/Fax

Practice location:
  • Phone: 954-770-1021
  • Fax:
Mailing address:
  • Phone: 954-770-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: