MEDICARE: DAMISLEYDIS DE LA CARIDAD DIAZ CUELLAR

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-25-505226	FL

General Provider Information

NPI Number	:	1164388328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMISLEYDIS DE LA CARIDAD DIAZ CUELLAR

Provider Business Mailing Address
First Line	:	811 NW 43RD AVE APT 516
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4134
Country	:	US
Telephone Number	:	786-714-4624
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 NW 43RD AVE APT 516
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4134
Country	:	US
Telephone Number	:	786-714-4624
Fax Number	:

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

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	12/31/2025

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