MEDICARE: MARIA I 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

General Provider Information

NPI Number	:	1174053516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA I DIAZ

Provider Business Mailing Address
First Line	:	4445 W 16TH AVE STE 411
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7191
Country	:	US
Telephone Number	:	305-397-3597
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 W 16TH AVE STE 411
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7191
Country	:	US
Telephone Number	:	305-397-3597
Fax Number	:

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

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	07/21/2022

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Directions to “ MARIA I DIAZ ” Practice Location

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