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General NPI Number Information
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NPI Number | 1629831615
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Entity Type | Individual
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Provider Name | STEPHANIE JULIET DIAZ
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Gender | Female
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 5881 NW 151ST ST STE 127
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2442
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Country | US
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Telephone | 786-905-2262
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Fax | 786-398-5500
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Provider Business Mailing Address
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Address Line | 9686 FONTAINEBLEAU BLVD APT 702
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City | MIAMI
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State | FL
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Zip | 33172-4140
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Country | US
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Telephone | 786-651-0922
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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-24-323525
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License Number State |
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