MEDICARE: DIANA FERNANDEZ

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		AZ

General Provider Information

NPI Number	:	1477497196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA FERNANDEZ

Provider Business Mailing Address
First Line	:	303 E SOUTH MOUNTAIN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7516
Country	:	US
Telephone Number	:	602-670-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E SOUTH MOUNTAIN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7516
Country	:	US
Telephone Number	:	602-670-5100
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ DIANA FERNANDEZ ” Practice Location

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