MEDICARE: YAMELA GONZALEZ 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	20-136327	FL

General Provider Information

NPI Number	:	1619481074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMELA GONZALEZ DIAZ

Provider Business Mailing Address
First Line	:	6224 SW 23RD ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2857
Country	:	US
Telephone Number	:	786-521-6920
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 SW 148TH AVE
Second Line	:	STE 110
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3237
Country	:	US
Telephone Number	:	954-734-2737
Fax Number	:

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

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	07/25/2024

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