MEDICARE: ISMERY DIAZ RBT

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	106E00000X	Assistant Behavior Analyst	0-21-12044	FL
2	106S00000X	Behavior Technician	1050546000	FL
3	103K00000X	Behavior Analyst	1-23-65167	FL

General Provider Information

NPI Number	:	1821622333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMERY DIAZ RBT

Provider Business Mailing Address
First Line	:	4844 NW 4TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2171
Country	:	US
Telephone Number	:	863-808-9456
Fax Number	:

Provider Business Practice Location Address
First Line	:	4844 NW 4TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2171
Country	:	US
Telephone Number	:	863-808-9456
Fax Number	:

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	05/12/2023

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Directions to “ ISMERY DIAZ RBT” Practice Location

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