MEDICARE: DIANNE AYALA 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	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician	RBT-20-143684	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1497334569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE AYALA PEREZ

Provider Business Mailing Address
First Line	:	18081 BASS LAKE CT
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-4803
Country	:	US
Telephone Number	:	239-848-6612
Fax Number	:

Provider Business Practice Location Address
First Line	:	18081 BASS LAKE CT
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33972-4803
Country	:	US
Telephone Number	:	239-848-6612
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	11/13/2023

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Directions to “ DIANNE AYALA PEREZ ” Practice Location

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