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General NPI Number Information
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NPI Number | 1457026544
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Entity Type | Individual
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Provider Name | DAIYALIS DIAZ VIVAS RBT
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Gender | Female
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 2119 10TH AVE N
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City | LAKE WORTH BEACH
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State | FL
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Zip | 33461-3345
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Country | US
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Telephone | 561-444-2458
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Fax | 561-444-2458
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Provider Business Mailing Address
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Address Line | 1033 WANDERING WILLOW WAY
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-6089
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Country | US
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Telephone | 954-655-3856
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-124537
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License Number State | FL
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