MEDICARE: DIANA ROSA CABEZA HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	0-25-16548	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093479685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA ROSA CABEZA HERNANDEZ

Provider Business Mailing Address
First Line	:	18101 PEREGRINES PERCH PL UNIT 206
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-2780
Country	:	US
Telephone Number	:	786-362-1103
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 MEMORIAL HWY STE 105
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4501
Country	:	US
Telephone Number	:	479-420-9849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	03/09/2026

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