=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306712385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANY ALLENDE DIAZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2025
-----------------------------------------------------
Last Update Date | 01/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7765 SW 87TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-2596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-294-4113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18111 NW 68TH AVE APT G210
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33015-3988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-384-4205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | 25-475316
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------