MEDICARE: DAMASA M 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	103K00000X	Behavior Analyst

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	:	1629427943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAMASA M DIAZ

Provider Business Mailing Address
First Line	:	2740 W 76TH ST APT 105
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5623
Country	:	US
Telephone Number	:	786-473-7751
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 W 76TH ST APT 105
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5623
Country	:	US
Telephone Number	:	786-473-7751
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	DAMASA M DIAZ
Credential	:
Telephone Number	:	786-473-7751

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	06/07/2016

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Directions to “DAMASA M DIAZ ” Practice Location

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