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NPI Code Detail

MEDICARE: JOHNNY JEHOVANY DIAZ

MEDICARE: JOHNNY JEHOVANY 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1255145462
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNY JEHOVANY DIAZ
Provider Business Mailing Address
First Line : 5850 GRANITE PKWY STE 600
Second Line :
City : PLANO
State : TX
Zip : 75024-6753
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10515 BALBOA BLVD STE 290
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-6362
Country : US
Telephone Number : 818-960-0633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2025
Last Update Date : 02/06/2025

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Directions to “ JOHNNY JEHOVANY DIAZ ” Practice Location

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