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General NPI Number Information
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NPI Number | 1568325009
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Entity Type | Individual
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Provider Name | KIMBERLY MARIE KIMBERLY DIAZ
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1551 BOREN DR STE C
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City | OCOEE
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State | FL
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Zip | 34761-2966
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Country | US
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Telephone | 407-223-1298
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 SUMMIT CENTRE WAY APT 206
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City | ORLANDO
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State | FL
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Zip | 32810-5985
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Country | US
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Telephone | 407-924-2092
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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 |
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License Number State |
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