MEDICARE: YANET BLANCO 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	BACB1163987	FL

General Provider Information

NPI Number	:	1770310732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANET BLANCO DIAZ

Provider Business Mailing Address
First Line	:	7604 CORTEZ CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7604 CORTEZ CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2924
Country	:	US
Telephone Number	:	813-446-9965
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/16/2024

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