MEDICARE: LORAINE 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	24397475	FL

General Provider Information

NPI Number	:	1316755853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORAINE DIAZ

Provider Business Mailing Address
First Line	:	1300 W 79TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3448
Country	:	US
Telephone Number	:	786-908-7940
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 NW 155TH ST STE 204
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5844
Country	:	US
Telephone Number	:	786-536-2037
Fax Number	:

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

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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Directions to “ LORAINE DIAZ ” Practice Location

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