MEDICARE: LEDIANNE DIAZ DIAZ

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	106S00000X	Behavior Technician	RBT-20135445	FL

General Provider Information

NPI Number	:	1154199156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEDIANNE DIAZ DIAZ

Provider Business Mailing Address
First Line	:	12401 W OKEECHOBEE RD LOT 378
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-5916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12401 W OKEECHOBEE RD LOT 378
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-5916
Country	:	US
Telephone Number	:	786-234-0589
Fax Number	:

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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Directions to “ LEDIANNE DIAZ DIAZ ” Practice Location

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