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General NPI Number Information
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NPI Number | 1386180792
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Entity Type | Individual
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Provider Name | MARIA DIAZ
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Gender | Female
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 3721 SW 59TH TER APT 4
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City | DAVIE
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State | FL
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Zip | 33314-2643
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Country | US
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Telephone | 954-470-3082
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Fax |
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Provider Business Mailing Address
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Address Line | 3987 NW 87TH AVE
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City | SUNRISE
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State | FL
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Zip | 33351-6584
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Country | US
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Telephone | 754-308-0984
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 1386180792
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License Number State | FL
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