MEDICARE: PABLO LUIS FERNANDEZ 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	RBT-25-421204	FL

General Provider Information

NPI Number	:	1407657752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO LUIS FERNANDEZ DIAZ

Provider Business Mailing Address
First Line	:	2500 NW 79TH AVE STE 224
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1085
Country	:	US
Telephone Number	:	786-916-7559
Fax Number	:	786-947-1236

Provider Business Practice Location Address
First Line	:	1403 W 43RD PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7607
Country	:	US
Telephone Number	:	305-629-0594
Fax Number	:

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

Provider Enumeration Date	:	03/22/2025
Last Update Date	:	03/22/2025

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Directions to “ PABLO LUIS FERNANDEZ DIAZ ” Practice Location

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