MEDICARE: JANLY 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	103K00000X	Behavior Analyst	12477463	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	:	1205459096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANLY DIAZ

Provider Business Mailing Address
First Line	:	16233 NW 86TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-8507
Country	:	US
Telephone Number	:	305-632-6935
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 NW 167TH TER
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-3426
Country	:	US
Telephone Number	:	786-863-5936
Fax Number	:

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

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	12/13/2024

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Directions to “ JANLY DIAZ ” Practice Location

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