MEDICARE: DIANA ROSA MEJIAS PEREZ

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	106E00000X	Assistant Behavior Analyst	RBT-20-134185	FL
2	172V00000X	Community Health Worker		FL

General Provider Information

NPI Number	:	1326653007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA ROSA MEJIAS PEREZ

Provider Business Mailing Address
First Line	:	2948 NW 180TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3483
Country	:	US
Telephone Number	:	305-619-4008
Fax Number	:

Provider Business Practice Location Address
First Line	:	2948 NW 180TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3483
Country	:	US
Telephone Number	:	305-619-4008
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	11/16/2021

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