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General NPI Number Information
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NPI Number | 1235665019
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Entity Type | Individual
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Provider Name | DELIO JESUS FERNANDEZ DIAZ
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 03/13/2021
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Provider Practice Location Address
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Address Line | 13301 SW 132ND AVE UNIT 209
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City | MIAMI
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State | FL
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Zip | 33186-6190
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Country | US
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Telephone | 786-713-5553
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Fax | 786-713-5559
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Provider Business Mailing Address
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Address Line | 10421 OLD CUTLER RD APT 107
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City | CUTLER BAY
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State | FL
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Zip | 33190-1721
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Country | US
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Telephone | 786-806-0308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-20-10934
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-48302
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License Number State | FL
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