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NPI Code Detail

MEDICARE: LISSAINET DIAZ BCBA

MEDICARE: LISSAINET DIAZ BCBA
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
2103K00000XBehavior Analyst1-21-53255FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467992594
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISSAINET DIAZ BCBA
Provider Business Mailing Address
First Line : 9143 SW 77TH AVE APT B803
Second Line :
City : MIAMI
State : FL
Zip : 33156-7656
Country : US
Telephone Number : 786-346-1123
Fax Number :
Provider Business Practice Location Address
First Line : 3520 OAKS WAY APT 904
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069-5387
Country : US
Telephone Number : 305-807-1909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2017
Last Update Date : 05/24/2022

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Directions to “ LISSAINET DIAZ BCBA” Practice Location

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