MEDICARE: DIANA P CERON

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

General Provider Information

NPI Number	:	1720838691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA P CERON

Provider Business Mailing Address
First Line	:	12460 SW 42ND ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-6002
Country	:	US
Telephone Number	:	786-270-8927
Fax Number	:

Provider Business Practice Location Address
First Line	:	12460 SW 42ND ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-6002
Country	:	US
Telephone Number	:	786-270-8927
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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Directions to “ DIANA P CERON ” Practice Location

Language	Start Address	Practice Location

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