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General NPI Number Information
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NPI Number | 1013305952
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Entity Type | Organization
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Legal Business Name | DIOSARK, INC
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 1546 42ND ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3604
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Country | US
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Telephone | 561-840-1647
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Fax | 561-840-6415
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Provider Business Mailing Address
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Address Line | PO BOX 221315
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City | WEST PALM BEACH
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State | FL
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Zip | 33422-1315
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Country | US
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Telephone | 561-840-1647
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Fax | 561-840-6415
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BERNADETTE WATSON
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Credential |
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Telephone | 561-840-1647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 674307296
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License Number State | FL
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