MEDICARE: AQUA ABA THERAPY LLC

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
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1235830506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AQUA ABA THERAPY LLC

Provider Business Mailing Address
First Line	:	140 S PALM VILLAS WAY
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 S PALM VILLAS WAY
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-1084
Country	:	US
Telephone Number	:	561-836-6520
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND CEO
Name	:	DIANA COBAS PADIERNA
Credential	:
Telephone Number	:	786-970-2543

Provider Enumeration Date	:	03/14/2023
Last Update Date	:	06/20/2025

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